young athlete with grade 1 anterolisthesis L5/S1

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  • Kbushman
    Participant
    Post count: 4
    #24492 |

    Hello,

    My 16 year old daughter is a competitive tennis player here in Florida with hopes of getting a college scholarship. She started complaining of lower back pain a few months ago which has gotten progressively worse. We took her to a sports medicine (non-surgeon) Dr. He sent her for an MRI which states “some degree of spinal dysraphism at the L5/S1 level. Right L5 spondylolysis without associated bone marrow edema. Mild bone marrow edema along the left pedicle and left pars interarticularis of L5 without a discrete fracture line identified. There is a resulting 3 mm grade 1 anterolisthesis of L5 on S1.” He doesn’t seem too concerned and has told her to rest for 6 weeks and start PT. However, in prior screenings she has been noted to have mild reversal of cervical lordosis and possible Chiari Type 1 malformation. After researching on the internet all these findings, I am getting very worried. Do you have any advice as to what we should do next? Thank you!

    Dr. Corenman
    Moderator
    Post count: 5297

    There are two processes that need to be looked at. The Chiari malformation you can read about at https://neckandback.com/conditions/chiari-malformation-type-arnold-chiari-syndrome/. If she is asymptomatic for this disorder, it can simply be watched.

    The pars fracture at L5 on the right disconnects the ring of the back of the vertebra and then places stress on the left side. This left side is more likely where the pain is occurring. She is developing a stress fracture at the left (“Mild bone marrow edema along the left pedicle and left pars interarticularis of L5 without a discrete fracture line identified”). I reduce activity in these patients for three months in a brace and then return to activity in an increasing stress-loading fashion. If the pain returns, I surgically fix the pars fracture on the right.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    Kbushman
    Participant
    Post count: 4

    Thank you for your quick response. In your opinion, will she be able to continue to play high-level tennis? Since it won’t ‘heal’ because it’s an old pars defect, what will prevent the pain from coming back as soon as she walks back on the court in 3 months? Because there is a 3mm slip should we be proactively looking to come visit you with the thought of surgery? Again, thank you so much. This has been devastating for her as her life has been centered around tennis.

    Dr. Corenman
    Moderator
    Post count: 5297

    The chance of continued pain after a three month respite is not low at 50% (or more). There are patient families that decide to repair the pars defect immediately. The healing rate for unilateral pars repairs is about 85%.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    Kbushman
    Participant
    Post count: 4

    Thank you, I’m going to fill out the consult forms and mail you her films to see if you think it’s feasible with the spina bifida occulta and 3mm slippage. I should note also that she is planning on having orthognathic surgery this May. I personally believe she has some sort of connective tissue disease but have never been able to get any diagnosis for her. I’m not sure how this plays into the thought of surgery? She has been an extremely active, athletic, happy kid and is very depressed now with all this.

    Dr. Corenman
    Moderator
    Post count: 5297

    The presence of spina bifida occulta makes more sense with a unilateral fracture as this means there are now two breaks in the ring. This is more typical for a unilateral fracture. Please contact Lori, my office manager Lori Fugate for further information.

    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.
    If this forum has helped you, please let Dr. Corenman know!

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