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L5/S1 Pars Fracture and Spondylolisthesis

From: rachaelllb - on 04/08/2013 1:04am

Hi my name is Rachael i am 22 years old and around 8 months ago i was diagnosed with a pars fracture and Spondylolisthesis on L5/S1. I believe it is from weight training. When i was 20 I took an intrest in fitness and started to do crossfit which involves weight lifting. i also cycle long distance. Anyways, it has been one long past couple of months. At first the pain was sharp in my back to the point were i could not laugh, sneeze, bend, ANYTHING. I waited for a week to go to the ER, because i thought i was just sore and it would go away. I finally went to the ER and they took x-rays said everything was fine, then dismissed me. I knew something was not right, i was having trouble feeling my legs, the sides of my legs were bruised from me pressing on them to relieve pain. I was having trouble sitting, standing and even sleeping. i was in and out of doctors for about 5 months until they finally decided to do an MRI and Cat scan, and that is were they found the pars fracture and slippage of the spine. I was so angry that it took so long to find out, then i asked about my options, whats next? He recommended because of my age that I try other options before I jumped right into the spinal fusion surgery. He started me on a medicine called Molexicam (mobic) which is a very strong anti-inflammatory used for arthuritus. At first everything was going fine. The inflammation went away, which was causing most of my pain but after two months the medicine gave me stomach ulcers and acid reflux and this was all around december. My doctor then switched me to another medicine like mobic that is easier on the stomach But it does not work as well for me as the mobic. It is now April and the stomach ulcers and acid reflux is not going away, it is getting worse every month. So now i have to juggle between back pain and stomach pain. I am lost as what to do about my spine, has anyone had a similar fracture? or no anyone who has? what options did you/they take? were they effective? anything will help!

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on 04/10/2013 9:18am

My daughter has the same condition and has been dealing with it for 4 years and she is just 15 and a competitive cheerleader who flys and tumbles. She has tried anti-inflammatory meds,, 2 different back braces, physical therapy, massage, and chiropractic with no positive results. She is scheduled for surgery in a little over a week (april 22) for a direct pars repair. She is looking forward to the surgery because the pain has made her quality of life suffer significantly. We are looking at a 6 month recovery and are happy that she should lose no range of motion because it is not a fusion.

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on 04/25/2013 2:51am

I was in your position 18 months ago and there is an alternative to spinal fusion. After trying a range of different treatments including physical therapy and injections I had injections into the pars defect which
gave an almost complete resolution to the pain. I have subsequently had a direct Buck repair of the fractured L5 vertebra This has the advantage of maintaining movement. See other blogs onthis site by Scott Hews

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on 06/09/2013 1:47am

Hi Rachael, nearly two years ago, I had undergone a very successful TLIF operation at L5/SI level. One year prior to this I was diagnosed with Isthmic Spondylolisthesis Grade 1 at the L5/S1 vertebral level. Like yourself, I had also experienced daily mechanical pain and furthermore I was told by a chiropractor that it was more than likely that my spondylolisthesis would not deteriorate any further and that conservative treatment ( I.e. physiotherapy, chiropractory, oral medication, and topical formulas) would suffice.

However, 8 months after being diagnosed, my pain levels had substantially increased and I was having intermittent flair up's which involved multiple disc bulges (this is the domino affect from a destabilized spine - spondylolisthesis was the stressor). Despite continued efforts to mitigate my evolving daily pain, conservative treatment was not helping and I was then starting to experience neurologic issues which involved intense sharp stabbing and burning neuropathic pain down my right leg (sciatic nerve irritation).

After persistent pain and obvious neural problems which were associated with the isthmic spondylolisthesis domino affect, I had undertaken extensive research for a prospective neurosurgeon before my first consultation in February, 2011. Upon my consultation with my neurosurgeon, he arranged an MRI for me and the results confirmed significant further deterioration involving Neuroforaminal stenosis (nerve impingement from narrowed foramina nerve canal) at L5/S1 level; disc bulge with annular tear and facet joint degeneration at L3/L4; and disc degeneration, broad based disc herniation, and facet joint degeneration at L4/L5 level. Upon seeing the evidence, my neurosurgeon arranged for me to have a Minimally Invasive Transforaminal Lumber Interbody Fusion (TLIF) with hardware at L5/S1 level.

Furthermore, I had my surgery on the 11th July 2011; and I am approaching two years post surgery. I must say that, I am feeling absolutely wonderful and my pain levels are 95% better than they were before surgery! Without surgery intervention, the reality is that I would have continued having long term crippling pain not to mention more serious neurologic deficits (I.e. loss of muscle function; incontinence; decreased leg sensations; leg weakness; abnormal reflexes; paralysis; and further deterioration of my lumber spine area) Therefore, not being able to work and maintain any quality of life.

My next post surgery milestone is my two year post-op review which is scheduled in July this year. At this review, my neurosurgeon will review a CT scan (taken earlier the same day) in order to determine the actual progress and integrity of my bone fusion.

From my experience, I can honestly say that surgery was the only effective outcome for me. Irrespective of being young, don't be deterred by surgery options.....there are positive outcomes!

Cheers, Robert.

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on 06/11/2013 11:48am

It iS important to distinguish between a fusion and a dIrect pars repair. A fusion Would br drastic for someone aged 22

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on 06/12/2013 7:25am

Hi Richard,

You are correct in stating that there is a difference between direct pars repair and fusion, however, direct repair of the pars will not correct the problems which are associated with spondylolisthesis (I.e. misaligned vertebral body; neuroforaminal stenosis; and neurological deficits).

Rachael has indicated that she was diagnosed with a "pars fracture and spondylolisthesis", though, no grade of slippage was indicated?

May I point out that, a stress fracture of the pars is typically the precursor to the domino effect which then subsequently causes instability and slippage of the vertebral body, hence, this is known as spondylolisthesis.

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on 08/14/2013 8:26pm

My daughter is now almost 4 months post op. according to X-rays everything is healing right on schedule. In the last couple of weeks she now has started having pain shooting down her leg. She is in so much pain she can hardly do anything. School started yesterday and she is having trouble even sitting in the desk. She can't walk on the treadmill or any of the things she is supposed to be doing to get better. She is also having trouble sleeping and having to sit on the sidelines and not do competitive cheer is mentally taking its toll on her. I am convinced she is depressed. I don't know where to turn for help. Her surgeon is on vacation and the office is trying to decide whether to send her for MRI because of the shooting pain. I would give anything to find a psychologist that deals with depression in teens who have undergone major surgery. Any thoughts from anyone?

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on 08/23/2013 7:40am

I recommend you arrange for your Daughter to undertake Acceptance and Commitment Therapy (ACT). Trusting that her pain issues have been identified?

Robert.

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