Viewing 6 posts - 13 through 18 (of 23 total)
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  • laura
    Member
    Post count: 3

    Hi Dr. Corenman,

    My 15 year old son began having lower back pain in July 2012 after playing baseball and football a lot in one week. He is also a wrestler. He has seen 2 orthopaedic doctors since then and has had several xrays, 3 MRIs, and one CT scan.

    In September he saw an orthopaedic surgeon specializing in the spine and was treated for a stress reaction/fracture of the pars at L3 based on edema at the pedicles of L3. He had xrays and an MRI. He was shut down from football and all activities and placed in a brace for 6-8 weeks. Following that, he had PT/core strengthening for 6 weeks. His back pain was better and he was released to return to all sports without restrictions. He gradually reentered wrestling practice and did not actually compete until January. He wrestled without pain during December and half of January, when he began weightlifting class, added to wrestling. He began having pain again and after qualifying for State in wrestling, asked to be seen by the doctor again.

    At that time we were reminded that he also has disc desiccation of L4-L5 and a presumed Schmorl’s node superior aspect of L5 with irregularity at the anterior aspect of the superior endplate of L5. The dr. wasn’t sure if the presumed pars fracture at L3 was causing the pain or the disc degeneration of L4-L5. He said we could either do an epidural injection both for treatment and possible diagnosis, but he didn’t recommend due to his growth plates still being open; or he could shut down again; or he could continue with baseball and just do activities that didn’t hurt.

    We weren’t satisfied with this plan so we decided to visit a pediatric orthopaedic surgeon. He ordered a CT scan, which he felt revealed a bilateral pars fracture of L3, although the official report said no evidence of acute fracture or dislocation of the lumbar spine. He feels his pain is from the pars fracture, not the disc issues. He has prescribed rest for 2-3 months, followed by PT, stretching, core strengthening, and gradual reentry to sports, which by that time will be football again.

    Our son is a very competitive athlete who is becoming somewhat depressed at his predicament. I’m just wondering if this is the course of treatment you would recommend or if there is something else we should be doing? Also, we live in Mid-Missouri. Is there someone who specializes in these issues that you would recommend? We have seen Dr. Craig Meyer and Dr. Daniel Hoernschemeyer in Columbia, MO thusfar. Do you think he will be able to return to sports, and if so, how long does it usually require rest?

    Thank you for your time and opinion!

    laura
    Member
    Post count: 3

    One more question…..do you think rest and conservative treatment is the way to continue to go, or when should we consider surgery to help either the pars fracture and/or the disc issues? We sure don’t want to have surgery, but we can’t IMAGINE him spending his high school career without sports! :(

    Thanks!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    If your son has pars fractures at L3 and the MRI or bone scan does not indicate any attempt at healing, these fractures will have little chance of healing even with rest and bracing. If the L3-4 disc is still normal appearing on MRI and there is no slip on flexion/extension X-rays, you could consider pars repairs. If there is degenerative disc disease present at L3-4, there is a slip of L3 on L4 or the gap between fracture fragments is large (greater than 3mm), pars repair will not work and fusion will have to be considered.

    If fusion is considered, a work-up may need to be undertaken to see if the L3-4 level is the only pain generation level due to the degenerative changes below this level.

    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.
    laura
    Member
    Post count: 3

    I’m not sure if the CT and MRI indicate whether it is attempting to heal or not…..the pars defect is at L3 and the degenerative disc is between L4 and L5. There doesn’t seem to be any disc issues with L3-L4, just L4-L5. There is no slippage noted. He has had one session with a college athletic trainer with a light force laser treatment. Said we should have 3-4 treatments and it could help. Any experience or opinion on this?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Superficial light laser is worthless for structural changes of the spine.

    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.
    sheryltc
    Member
    Post count: 6

    Read our story at the beginning of this post. Since posting this, someone contacted me privately to tell me their story. His son had a similar incident to my son’s. He actually lives in our area and his son had surgery in October for the pars defect. We were able to get an appointment too!! This dr is a neurosurgeon at a spine center in Atlanta, GA. My son is actually scheduled for the repair this month. We are so thankful for this site and that someone reached out to us. After seeing a total of 8 doctors (chiropractors, pain management, orthopeadics) we have found a specialist that feels very confident that he can help my son through this surgery! Please let me know if you’d like more information – I cannot post details here – but I can contact you privately.

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