My daughter is 17, and was diagnosed with a stress fracture in the growth plate in her back. She took 4 weeks off from pitching, (she plays softball), had PT, rest, ice, etc. After resuming play, she still had some pain, but it was better. Fast forward almost 2 years, the pain has gotten increasingly worse, with nerve pain down her legs and hips.
After more tests, she has been diagnosed with Pars Defect with 2 fractures, one on each side. She has stopped most activity, and is still doing PT on her own, but the pain is at best tolerable, at it's worst debilitating. The level of her pain is now affecting her daily activities and she makes decisions regarding almost everything she does based on the pain level.
We have been referred to a surgeon, as there does not appear to be many other options at this point. I would love for her to play softball one more season, but is seems as if that is not going to be possible. Right now, we just want her to regain the normal activities of a typical teenager without constant pain.
What experiences have you had both positive and negative with this condition, the surgery, the recovery, etc. Anything you can share with me would be greatly appreciated!
Post by Glenn Fleisig, Ph.D. on Dec 9, 2012 9:30:03 GMT -6
This is what a spine surgeon I respect told me to share with you:
A lumbar 5 bilateral root block may be worth trying (if it is a lumbar 5 defect).
Unfortunately, from what it sounds like the surgery would entail a fusion. This would require bone healing and before return to competitive sport may take the better part of 9 - 12 months. The outcome can be quite satisfactory (if it is one level). There have even been a few pro football players who have returned after this (but they are the exceptions).
I'd recommend seeing a physiatrist also although she may get this advice from a surgeon. It doesn't sound like she ever took enough time off to heal. It generally takes about 4 months of inactivity (no running, no jumping, no arching the back, no twisting the back) to heal, not just 4 weeks off from pitching. Surgery, although it may eventually be necessary is something to be avoided if possible. She probably needs to halt activity, including PT, for a couple months and wear at least a soft brace to remind her not to do anything that would aggravate it through about 4 months. Low Intensity Pulsed Ultrasound may be an option to possibly aid healing but it sounds like it may simply be a non-union or fibrous union that isn't going to heal with bone. If the approximately 4 months off from sports works then there will always still be the possibility of flare ups that will require shutting down and going back into the brace for a few weeks until the pain is gone and she can work back into it gradually again.
My son had a stress reaction or stress fracture (based on MRI) at L5 at 14yo, a bilateral fracture at L3 at 16yo (based on CT), and a stress reaction at L5 at 20yo (based on MRI). We used the LIPUS and he healed with bone based on the CT scans. He'd had plenty of radiation from CT scans and had finished playing college baseball by 20yo, although the injury resulted from baseball and was aggravated after he switched to track by pole vaulting and mostly by throwing the javelin, so we didn't follow that up with CT. Each time it took almost 4 months for healing although the LIPUS did seem to speed it up a bit and at 20yo he stopped trying to be a decathlete and stuck to sprints after rehabbing so we were a bit less concerned about his being fully healed before starting to train again.
Just guessing here, but the surgeon that Dr. Fleisig spoke to may be assuming that the Pars Defect may be something that can't be healed and that the nerves in the area have been sensitized so a block might stop the pain and possibly allow her to continue with sports. There are a quite a few people with pars defects who are asymptomatic.
Last Edit: Jan 3, 2013 17:36:34 GMT -6 by miketace