Donald CorenmanKeymasterApril 25, 2011 at 3:31 amPost count: 52
I am an 18 year old tennis player. I saw your video on youtube but it wasn’t much comment room. I am contacting you to hear what you think. I was diagnosed with a right sided pars fracture of L5. The CT scan showed that it was healing. My doctor said that I don’t need the brace because I wasn’t in much pain when I saw him which was 2 weeks after I stopped playing, and he said my left side is holding everything in place for the other side to heal. Do you think that my left side could break from daily living? I haven’t done physical activity(running, weight lifting, tennis). All I have been doing is physical therapy and resting. Do you think that if the CT scan showed that the fracture was healing it will heal all the way, bone to bone? I am not in any pain right now, although I do feel at the site of the fracture some bump it doesn’t feel tender though. So do you think this will heal and I will be fine, or do you think I need to get the brace? It is going to be 12 weeks on friday that I haven’t played tennis. My doctor wants me to get a bone scan to see if it is healing still or not, but the bone scan won’t show if its healed or not, it will just show if there is bone activity still going on in that area? And I don’t want to expose myself to anymore radiation. What do you suggest I do?Donald Corenman, MD, DCModeratorApril 25, 2011 at 3:34 amPost count: 8468
A unilateral pars fracture of L5 is very common in tennis players and professional skiers. The serve and overhead both cause significant extension (bending backwards) of the spine and this can overload the bone causing this stress fracture. Make sure this fracture is not a facet fracture (a lower fracture in the same bone) as the facet fracture has a different prognosis.
If this is truly a unilateral pars fracture, there is a good chance it will heal but healing will take at least three months. This means no tennis or any exercise that would put your back into extension. Think of this fracture as an ankle fracture. I don’t think you would run, play tennis or lift weights with an ankle fracture- so treat it as that.
Bracing is optional but I like to use braces for this fracture as it reminds you not to bend backwards which destroys the healing potential. This fracture may not heal in spite of your carefully reduced activity. Without healing, the other side that is intact will react to the increased stress. It may go one of two ways. It may develop more bone to compensate for the increased stress (hypertrophy) which is a good development or it may eventually fracture from the overloaded stress.
If the other side does hypertrophy, the pain most likely be reduced but may not completely go away under load. Healing potential can be ascertained with a bone scan but the MRI can also give similar information without a radioactive tracer being used. I always obtain a new limited CT scan (just the fracture area and not the entire lumbar spine) in athletes to look for healing. The fracture is repairable surgically if necessary.
Hope this helps.gary.notkinMemberApril 25, 2011 at 6:23 amPost count: 3
Thank You for replying. This is for sure a pars fracture. So you are saying that if the CT scan showed healing on March 1st that means it will heal all the way? Or it could stop healing half way even if there was healing bone on the CT scan. Do you think I should get the brace now? It will be three months this friday coming up. You think it will still hurt when I start to play? I am hoping to play college and pro tennis and I can’t live without tennis. I don’t want to do surgery, because I know that this is treated conservatively with good results. So what do you suggest I do? I know there are athletes on the pro tennis tour playing with this and they are fine. I am ok with having a little soreness here and there when I start to play again but I don’t want to have the kind of pain that I had when it first happened back in January. I am also using a bone stimulator right now, do you think that might help too? And you are sure that MRI will show if it is healing, because I don’t want to expose myself to more radiation, I did get a localized CT scan of that area at first, but I don’t want to do it again. By the way where is there more radiation Bone scan or localized CT scan, if you could let me know about that too I would appreciate it. ThanksDonald Corenman, MD, DCModeratorApril 26, 2011 at 4:01 amPost count: 8468
I always worry about a report that notes the “CT scan demonstrates partial healing” as partial healing could mean anything. Ask your doctor if he could replace the bone scan with another limited CT scan of just the vertebra in question. Three months is the quickest time a pars fracture could heal and it can take up to six months. If the CT notes a healed fracture, you would not need the brace. If the CT notes delayed healing- my opinion would be to use the brace. Healing potential can be ascertained by an MRI using the STIR images. If the fracture doesn’t heal with conservative management, you could try to play tennis with the fracture and if it becomes too painful, you could have the fracture surgically repaired.
Dr. Corenmangary.notkinMemberApril 26, 2011 at 5:23 amPost count: 3
What do you mean the partial healing could mean anything? The CT showed the right pars, but it looked more like a stress reaction, it wasn’t cracked all the way through because there was already bone healing. So it could have stopped? Why is this issue so complicated why can’t it just heal like everything else in the body? The bone scan won’t show if its healed or not, it will only show if there is still healing bone?Donald Corenman, MD, DCModeratorMay 1, 2011 at 3:00 amPost count: 8468
If the pars is reported to be “partially healed”, that definition depends upon the interpretation of the radiologist. A pars fracture can heal without a full joining of 100% of the bone ends. If the other side of the vertebra is not fractured and the fracture side has 50% of the fracture ends fully united, more likely than not it will withstand extension. Extension occurs with your serve and overhead.
The reason the bone fractured in the first place is the significant forces to the pars generated with these actions. It is a possibility that the fracture can occur again. If the fracture occurs again, you might need a surgical pars repair.
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