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adolescent spondylolisthesis L5-S1 due to pars fracture

Started by SheilaM on 03/22/2010 2:31pm

Hi, my daughter is 14 years-old, and had surgery Sept. 2009 to repairs bilateral pars defect/spondylolisthesis grade 1. She's a competitive soccer player, and was having a great deal of lower back pain... Now here we are.
The latest CT Scan, March 8, showed non-union of the bone graft on one side. She is using bone growth stimulator daily, taking calcium, etc. I am just wondering if anyone else has a child with this condition, and if there is anything else we can do to help her bone graft to heal. We were told she may need surgery again for the non-union of the bone graft, and needless to say, are hoping to avoid that.
Also, we were told persistent non-union would result in her needing a spinal fusion. If that's the case, is there any possibility of her playing soccer again? Does spine fusion really mean no more physical activity?
Thanks in advance for any information on this topic!

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What do you think caused this?

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We don't know what caused it. She plays competitive soccer year-round, and we've learned this problem can occur in adolescent athletes perhaps from putting the same type of stress on the spine oer and over. Before this happened, she also played basketball, ran track, etc.. so soccer was not the only sport. There was not one specific injury which caused this, she just started mentioning that her back hurt. The other thing we've been told is it may be genetic, but I don't know.

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I hope your daughter gets better.

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5-7% of the population will be born with a predisposition to a weakened spine at or around l5/s1. During the ages of 5-13 if sports and activities such as gymnastics, football, etc are played in these individuals, then it could cause their weakened spines to turn into pars defects, then as a teenager, pars fractures leading to possible spondylolisthesis. There are 5 types of spondylolisthesis and the one I'm talking aboutis isthmic or sumthing like that. It CAN be hereditary...so far, 2 out of 4 of us in my family have spondylolisthesis which turned symptommatic. Hope this helps.

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Hi! I am sorry to hear about your daugther! I had myself fusion on the L5/S1. I experienced a lot of pain on the back after the surgery and even now after 6 months I have strong pain on the knee and leg. The doctor says that now the root nerve is irritated or inflamated, otherwise the bone has grown around the implant. I strongly recommend that she stops playing soccer. 2 months after I had the surgery, a small accident had happend, I almost fall from a chair when I was about to sit down, and since then the pain has coming back stronger on the leg and knee. I imagine if something happens when she plays soccer, a fall might be enough ( as in my case) so the problems on the back reappear. later on, she will want to have children, and keeping a pregnancy it is not easy for the back either. In my case, I start having back problems during my pregnancy time. I hope everything will go fine for your daugther! Good Luck.

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Thanks for your post. She is not playing soccer right now. She has a great attitude, still goes to every practice & game to support her team. We are still hoping she can return to the sport she loves someday. But yes, we also need to think long-term with regard to her having children in the future, and the possibility of long-term back pain. That is more important, although devastating for het to give up on her dream of playing soccer in college . She is having a CT scan, right now actually, and we are hoping to see some improvement in the bone graft. Good luck to you, and I'm sorry to hear about the pain you are living with on a daily basis.

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Sorry to hear about your daughter. I hope she'll be able to play soccer again...don't want her to have to give up her dreams. I too may have been born with the same thing, but my pain didn't come on until I was in my 30s and of course it's still around. I hope and pray that she'll get back on her feet after some Physical therapy. There are people who have successful back surgeries and are able to resume their normal activities after a year. Just keep the faith....she'll be back on her feet in no time!

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I had an L5-S1 fusion in 1997 at 21 years old to repair spondylolisthesis at that level. I was playing volleyball in college at the time. The rehab took a full year before I was completely healed but it has completely solved my problem. I had consistent pain before the surgery. Couldn't stand or sit for long periods of time but now it is almost entirely gone. Occasionally I have a little soreness in my lower back. For rehab I walked as much as I could every day and started lifting weights after about 6 months (mostly upper body, no load bearing through my lower back, with the approval of my surgeon). After rehab I continued to play volleyball as well as soccer, softball, golf, tennis, running, etc. So, NO, to answer your question, the fusion definitely does not mean the end of all physical activity, in fact, the fusion is the only thing that has allowed me to have an active lifestyle as an adult! Good luck!!

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Thank you for the response! I'm so glad to know you have continued to be an athlete after the fusion. That does provide a little peace of mind, just in case we need to worry about that in the future. My daughter is doing very well right now and we are hoping, obviously, to avoid future surgeries. She's a freshman in highschool and is a starter on the JV soccer team. So far, she is doing great and is the high scorer on the team.

She strained her psoas muscle (hip flexor strain) right before tryouts, so she had to go back to PT for that. Her previous PT had her strengthening her core muscles but did not address her hip muscles. Now we see she should have been working those muscles all along also. My daughter does many exercises/stretches every night after practice. I have such admiration for all of you who are dealing with back pain every day.

We are still waiting and hoping for her bone graft from the surgery to heal completely. We'll go back to doc in Sept, (one year post-op) and he'll let us know if he thinks she'll need surgery again to redo the bone graft. In the meantime, we are grateful every day she begins to feel a little better and is able to play the sport she loves so much.

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dr terry a rondberg dc

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I am a 49-year-old man father of two, I had a fusion two months ago. My son is 14 whenever he hurts himself he heals real fast. I would think your daughter would to. If she had a fusion she should recover real fast. The people that recover from a fusion go back to doing everything. I would think your daughter would be able to play sports again. For me the fusion was a tough surgery. Dealing with children its very hard because she could get fix with a fusion. And never have a pain ever again. Just remember it's a one year recovery time. Good luck with your decision. Sam

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My son is 14 and is a very active athlete. He was playing freshman football when he began to have pain this year. We are so scared for the surgery. It is planned for December sometime. If you have any specifics on before and after surgery care I would appreciate them. We are still in the MRI/CT Scan/Consultation stages. All that we find to read are horror stories. And your daughter's bone graft issue is just one more. Hopefully we can gain more insight from what you might share.

Thanks-
Judy

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Hi Judy, Sorry just getting this..
Just to offer you a bit of hope and good news. My daughter will have a CT scan again in January (15 mos. post-op), to determine if the bone graft is healed. The good news is that at her last appt, the doc. said most likely she will not need surgery again for the bone graft. He said this because she was able to play soccer all fall season with very little pain. It was scary (for me!) to see her getting knocked down during the games. But she did great. He said either the bone graft is healing, or at least it is providing enough support to her back that surgery will not be needed. We're hopeful and anxiously waiting for the CT scan.

You had asked for advise re: recovery. One thing I can share - My daughter went to physical therapy for months, working on her lower back and core muscles. When she started back to soccer, she pulled a muscle in her hip! (psoas, I think). she had to go back to PT, to work on her hip. The new PT said she should have been working her hips, core and back muscles all along, to prevent hip injuries later. I wish we (or our first PT) had known that! Good luck to your son. I think the surgery is definitely worth it~! Sheila

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Judy, How is your son recovering? I know it will be a long road but I hope the surgery went well. Sheila

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Hi Sheila!
My son is 15. He was diagnosed with spondylolysis in July of this past year. He thought he had just pulled a muscle in his back a couple months prior, but with all his activities.. he was in rec ball, travel ball, then made summer high school team as incoming freshman &also summer football camp(all by his choice). World Series time he had progressed to the point that he couldn't walk. Long story, we received diagnosis, 8wks of no activities, 8 wks of rehab & easing back into things while continuing to do his core strengthening. We went back today to neuro & was told that it has now progressed to the lylothesis... shocked, stunned... sad!! He is not really having any symptoms & I was stunned to hear that it had progressed. He said we would treat it as symptomatic at this time & see how it goes... he has told my son no contact sports, etc... but also possibility of surgery. Was there a concern for your daughter having surgery so young on her back with her not being fully grown & possibly having growth spurts & needing more surgery? Was the one dang question I didn't think to ask!!! My son is almost 6'1 & has not stopped... might I ask what state you live in? We have seen 2 docs, one an ortho from the Andrews Institute who is not really a specialist in this injury & then the neurosurgeon, but I stay more confused each time I see one or the other because of conflicting statements made by them. Was told by ortho 6wks ago that he had bone growth & appeared to be healing, I didn't think that was possible.. then today we were told it has progressed.. sorry for the rambling! Thanks!

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also, we live in northwest Fla..

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Hi slemberger!
Sorry to hear about your son. To answer your question about her growth, we did have concerns about that because our daughter is only 5'3" - not too short by any means but her 2 sisters are about 5'6" and her brother is taller and still growing, and we were kind of hoping she would grow another inch or two! The doctor said the surgery would not affect her growth at all. If she was going to grow anymore it would not be related to this surgery. I asked him if the injury to her back (we don't know when it happened so it could have been years ago) could have affected her growth before the surgery, and we never got a definite answer. I guess there is no way of knowing... Also, we live in Louisville, KY. We see Dr.Puno at the Spine Institute. Dr. Puno has been great and is highly respected in our area for working with adolescents with back issues. Hopefully your son will heal with rest, and can avoid surgery. He sounds very active and athletic so I'm sure he will be back to sports soon!

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Not sure if I answered your ques. exactly.. he also said if she did happen to grow a little more she would not need more surgery. Her hardware is in her back for good, and even if she grows a couple inches the hardware will not be affected by her growth.. good luck!

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actually, you did answer.. my concern was that if it progressed & we were faced with surgery would it matter if he wasn't done growing. Like you, we have no idea really when or exactly how this injury occured, which is frustrating to me. I want to know! That being said, we are just hoping that with his workouts & strength training that he will continue to stay pain free even though we know the injury is still there. We have a neuro who strongly advises against any contact sport ever again.. says baseball is ok, but nothing else. My son wants to play it all. During our conversations with him, soccer was one of the things he advised against as well. Is nice to hear that your daughter is back doing what she loves. Do you think her chances are shot for scholarships & all or does that still look promising for her? My first concern was is he going to take a hit & become paralyzed.. I was assured that this was not something that would happen which eased me some. However, I am now with so many mixed emotions as to what to do. I can't put him in a bubble & protect him forever & we know this is here to stay & at some point in his life we will have to deal with it so I am now thinking I am just going to let him go for it all & see how things go.

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i am 24 i was diagnosed also when i was 14 i countinued to play sports and now i wished that i would have had the fusion now the doctor says if i dont have a fusion with in 6 months i will be paralyzed i have severe pain everyday all day so i recamend her having surgery as young as posible

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