- 15 yo athletic son has had 10 months of Left lower back pain. MRIs & xrays showed left spondylolysis in June, and now bilateral, complete fracture but still marrow edema. Also disc herniation L5-S1. - He's been in a lumbar corset for 6 months and stopped playing competitively 10 months ago, and suspended all athletic activity 6 months ago. He's been recommended by one orthopedist for PLIF fusion. - We'd really like to find out what non-surgical options are available and are considering (1) cortico-steroid injections to reduce inflammation around pars defect (Might the spondylolysis heal?) (2) prolotherapy (3) sonocur shockwave therapy. Does anyone know if any of these might effective? - Are there any other options we should be considering? - If we end up with the surgery, we're also trying to understand the differences between TLIF & PLIF as different surgeons seem to recommend one or the other, either open or Minimally Invasive. Thanks so much. :Dani
Post by Glenn Fleisig, Ph.D. on Dec 2, 2012 18:24:46 GMT -6
This is what I got from a spine surgeon I trust:
Consider trying a block. Pars probably will never heal but who the block could make it asymptomatic. Disc herniation can resorb on its own (but it may not). PLIF refers typically to bilateral interbody device placement. T(ransforamenal)LIF usually unilateral device placement (via foramen...slightly more lateral entrance point). Dealers choice as good arguments can be made for either. M(inimally)I(nvasive)S(urgery) not always all that it is cracked up to be as plenty of surgeons will not obtain as good a fusion bed. In the right hand, a decent option but an excellent technical job is more important!
You might want to ask your doctor about Low Intensity Pulsed Ultrasound treatment. I wouldn't assume that it would work at this point in time but there may be a chance. If insurance won't cover it the units can be purchased on e-bay at fairly reasonable prices.