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Hi. My daughter has had a stress fracture for over a year. She was a competitive gymnast and the pain initiated as left hip pain. MRI of the hip just showed inflammation. She did almost a year of pt with no improvement and the right also started to hurt. Pain was always hip, back and groin so doctors and pts said it was the psoas muscle. Finally a new dr thought to x-ray her back and saw the stress fracture. CT scan showed 5mm fracture on left and 3mm on right at L4. And that it was an old fracture. Bone scan showed no activity that it wasn’t healing. She is now in pt for her back. She is only 14 and otherwise healthy how can her body not be healing? The next step seems to be a spinal fusion. But the more I read about it the more scary it sounds. Surgeon also said the fusion may not take. Hate to go through all that and have it not work. She can walk. But can’t run, jump, bend down, or participate in pe class. Is there something we can do to stimulate bone growth or healing? Is it possible to avoid surgery with pt?
Thank you.Pars fractures do not heal well in many adolescents. I would put the lack of healing rate at about 50% treated appropriately (brace and activity restriction). Spinal fusion may not be necessary if there is minimal to no slip of the upper vertebra to the lower vertebra. If the disc appears normal on MRI and there is minimal slip, the pars can be repaired with about an 85% success rate.
If there is a significant slip or the disc is degenerative, she might need a fusion. See the section on pars fractures on this website to understand these concepts. Success rate for fusion in my hands is 99% so the “fusion should take” when performed meticulously.
There is no PT or bone stimulator that will heal a pars fracture that is established.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Thank you so much for geting back me!
She has not had an MRI, just CT and bone scan.
Besides the pars defect the CT report says :“There is a 1mm of anterolisthesis of L4 relative to both L3 and L5. A small broad based disc bulge L4-5 does not cause significant stenosis. There is no significant central canal or neural foraminal narrowing at any level. The lumbar spine is otherwise normal in appearance.”
Not sure if this says anything about slippage. You said she may not need surgery and repair rate was about 85%, without surgery how would it be repaired?
We are in Virginia, and it was a Dr at UVA that said he would do the surgery if we chose to but wouldn’t recommend it. Are there in any doctors you would recommend on the east coast? Otherwise, with a 99% success rate I would be willing to fly to Vail.
She is currently wearing a soft brace. The back is plastic with an opening over the spine and it is tightened in the front with Velcro. She says wearing the brace makes it feel a little better.
Just not sure what our next steps should be.
Thank you again for the help.You have to understand these numbers I gave you. First, the question is whether she is a candidate for a surgical repair of the pars defect. This would depend upon an MRI which would show the health of the disc.
If she is a candidate for a repair, the success rate for repair is 85%. That is, with 100 patients who obtain a repair, 15% would not have a successful repair and 85% would.
My fusion rate is 99% but that does not mean success rate. Success is defined by answering the question “would you do this surgery again knowing what you know now?”. Generally, 90% of patients would answer yes but not 99%.
Sorry but I do not recommend doctors at this point.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.My confusion is what is the difference between a surgical repair and a fusion? I didn’t realize there was any other surgical option besides fusion.
I did read the section on this site about pars defect.
Read the section under “Pars fracture repair” in the surgical category to understand what these repairs do and the indications for repair.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books. -
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