[rodintx]

#23226

My 12yo daughter is a competitive gymnast who works out about 25 hours per week. In January of this year (2016), she was in a tumbling accident from a back handspring gone wrong that resulted in a open, compound fracture of both the ulna and radius. After the immediate injury was attended to, I became concerned about spinal injury, considering her spine folded completely in half during the accident. The pediatric surgeon did not seem concerned about the spine and xrays showed no red flags for the chiropractor, either, so I let it go while her body healed.

She stayed as active as possible, but wasn’t released for full gymnastic use of her arm until mid-July. Within a few weeks, she began complaining of back pain. Gymnasts are used to pain and so the first inclination is to minimize it and resort to ice and massage. But the pain has persisted despite chiropractic, massage and muscle relaxers. I finally began to wonder if she was experiencing pain that originated from her original accident that had lain dormant until then because it had never been detected, so I took her to see a sports-specialized orthopedic.

Since stress fracture is relatively common in young gymnasts and her pain seemed to be triggered mainly when bending backward, the orthopedic ordered an MRI to see if the pain could be new pain altogether or, like my concern, acute pain from an old injury. The MRI came back with no stress fracture, no spondylolisthesis, no disk bulge, no disk protrusion or spinal narrowing, but it find this:

“Incidental note made of a transitional L5-S1 level with sacralization of the L5 vertebral body.”

After the MRI report, the orthopedic pretty much dismissed us with the suggested ice treatment and I took to the internet to learn more about sacralization. To be honest, there isn’t much out there about it, especially in the context of athletes, but the consensus seems to be that it is generally asymptomatic. However, when my daughter describes her pain, she says it feels like “bone on bone”. She has always been extremely flexible in the spine, but now finds herself with a more limited range of motion.

Is it possible that the sacralized L5 could be a source of her pain or would it have shown up long before now if so? If the sacralization is partial (which wasn’t clarified), could it cause “bone on bone” pain? Should we be looking in a different direction or is there anything from her story that sets of alarm bells from your experience? Where do we go from here?

[Donald Corenman, MD, DC]

#23229

Sacralization is not typically a pain generator if it is complete (both sides sacralized). There is a condition called Bertolotti’s syndrome which is associated with partial sacralization that can be painful. See https://neckandback.com/conditions/bertolottis-syndrome-colorado-spine-surgeon/. Make sure the MRI has STIR sequences and is read by a spine radiologist so not to miss pars fractures.

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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