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  • Kelly
    Member
    Post count: 2

    Hello,

    I am a university student majoring in a fine arts dance program. Five years ago I was diagnosed with unilateral spondylolysis on the right sides of my L4 and L5 vertebrae. When I was first diagnosed I was put in a back brace for 3 months and was in physiotherapy for 4 months. I was told that the healing process would take a long time and, because my pain had greatly reduced over the course of the 4 months I was in physio treatment, I was released to do home exercises on my own. I did exactly that and waited for the day I would be back to normal but that day never came. I have had chronic back pain in the same place (localized around the L4-L5 and S1 region) for the past 5 years with extension and even flexion!

    Now that I have started dancing about 16 hours a week in school, my back pain has only increased. I am in physiotherapy once again and an MRI has been ordered for me. I was just wondering how it could be that I have never been pain-free for all these years! I am only 22 and on some days it feels like I have the back of a 70 year old. I will not get my MRI for another couple months, but in the mean time, should I be worried about my condition?

    I have not been doing any back extension bends for the past three weeks and it looks like I will not be allowed to do any jumps either since my pain has increased. I have to take it day by day. Some days the pain is at a 1, 1 being only slightly painful, and other days it is at a 7. It seems I do not even have to do anything to set the pain off! What should I do because if I cannot participate in my dance classes my grades will go down? :(

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    You have been diagnosed with a unilateral spondylolysis at two levels when you were 17 years old and have lived with this for the last five years. You have had chronic back pain for the that five year period and brace treatment did not heal the pars defects. I assume you do not have any significant leg or buttock pain. True?

    The first question I have is how were these pars defects diagnosed? Did you have a CT scan? Did the scan reveal unilateral defects of the pars or the facet? This is a significant difference as unilateral pars defects normally heal if braced (although at the age of 17, the healing potential is less). Facet fractures, which look like pars defects but the fracture line is a little lower, typically don’t heal and create a great deal of pain.

    The MRI or a bone scan can determine if the opposite pars is under stress and potentially developing an impending fracture. The MRI can also determine the health of your discs. A new CT scan can determine if the opposite pars is intact or has fractured as a new development.

    Pain can occur not just from the unilateral pars defect, but from the opposite pars which is under much greater stress and can have an impending fracture (although after five years, the opposite pars should have fractured by now if there was an impending fracture). Pain can also occur from degeneration of the disc which can result from pars defects but normally does not occur with a unilateral defect.

    The pars fracture can cause bone spur formation which can compress the nerve and cause buttocks pain. This pain typically occurs with standing and walking and disappears with sitting but in the later stages can be present continuously.

    I think you need a full work-up from a qualified spine surgeon to know what to do.

    Dr. Corenman

    Kelly
    Member
    Post count: 2

    It is true that I do not have leg or buttock pain. As for the type of fracture, I am not actually sure if it was my pars or the facet that was fractured because I was just told it was spondylolysis which I assumed meant that it was the pars. I was never given specific details.

    For the diagnosis, I first had an x-ray taken but they could not conclude anything from it so I had a bone scan done which is when they confirmed the stress fractures at my L4 and L5 levels. I have the most pain when doing back bends but I also have pain with forward bends and after sitting or standing for a prolonged period of time. The pain is the least when I am lying down.

    Maybe my condition was not dealt with properly because I never had any follow-up scans or tests scheduled after my physio treatment to confirm whether that area was healing. At least now I will be having an MRI so I can get to the bottom of this mystery once and for all!

    Thank you for your comments!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    You report your diagnosis of spondylolysis was made with a bone scan as the fractures could not be seen by standard X-ray. You apparently never had a confirmation by a CT scan.

    Bone scans are designed to light up where bone metabolic activity is very high such as in a pars fracture that “is attempting” to heal. Bone scans will not light up at a pars fracture that has no metabolic potential (no “attempt” to heal).

    The problem with using a bone scan by itself to diagnose a pars fracture is that one side may be “quiet” or non-reactive as it has already fractured and now the opposite side is in the process of fracturing and “lighting up” or reactive. A CT scan is necessary or at the minimum, an MRI to actually visualize the area to determine the integrity of the pars.

    Good Luck!

    Dr. Corenman

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