280819 What does your doctor do about it? By Rickey Dale Crain

280819 What does your doctor do about it?

By Rickey Dale Crain

If your child presents with any of the symptoms described earlier, you doctor will order an X-ray of the lumbo-sacral spine to rule out spondylolysis. Very often, the oblique views are best for revealing the defects in the pars interarticularis. If there is spondylolisthesis or slip, the lateral view will show it best. If your child has spondylolysis, treatment is directed towards reducing the backpain by use of anti-inflammatory medications like Ibuprofen, and stretching and strengthening exercises for the back and abdominal muscles. In more severe cases, a lumbosacral support and Physical therapy may be ordered. After 1 to 2 weeks of rest, the pain usually goes away, and the child may resume sports. In the most severe cases where there is severe trauma and muscle spasm, a nuclear bone scan may be done to check if the pars defect is indeed a fracture.

If so, it may be necessary to place the child in a rigid lumbosacral orthosis or even a body cast. Sports will be curtailed for 3 months to allow time for healing. In patients with spondylolisthesis, the treatment depends on several factors, depending on age, sex, and severity of slip. The younger child has a higher chance of further slip with growth. Girls are more prone to progressive slip than boys. Severity of slip is estimated on the lateral view on X-ray, and depends on the amount of contact left between the L5 and S1 vertebral bodies. Grade 1 indicates more than 75% of contact. Grade 2 indicates 50 to 75% of contact. Grade 3 indicates 25 to 50% of contact. Grade 4 indicates less than 25% of contact. The higher the grade of slip, the more serious the problem, and the higher the chances of further slip. A CT scan or even an MRI may sometimes be needed to further elucidate the bone and nerve problem before treatment is started. For Grades 1 and 2, conservative treatment is usually instituted. This will be similar to treatment for spondylolysis, except for use of a rigid Lumbosacral orthosis LSO or thermoplastic brace), and intensive physical therapy to strengthen the back and abdominal muscles, as well as stretching exercises for the tight hamstring muscles. X-rays (lateral views only) are done every 3 to 6 months to check on the severity of the slip. If the patient responds to conservative treatment, the pain resolves, the hamstring tightness improves, and the patient may return to limited sports. Gymnastics, weight-lifting and football should be avoided. If the pain does not improve, or if follow-up X-rays demonstrate further slip, surgery may be needed. Surgery consists of fusing the L5 to the S1 vertebrae to prevent further slipping. Depending on the degree of slip and other factors, your surgeon may fuse the vertebrae “as is”, or fuse the vertebrae after attempting to reduce the slip. This latter technique entails significant risk to the spinal nerves, and will have to be taken into consideration in the pre-operative planning.

NOTICE: The information presented is for your information only, and not a substitute for the medical advice of a qualified physician. The author nor the publisher will be responsible for any harm or injury resulting from interpretations of the materials in this article.

What can be expected after treatment?

If your child has spondylolysis discovered incidentally, and has no symptoms at all, there is no need to restrict his or her activities. As long as he or she has no symptoms, no regular follow-up is needed. If your child has spondylolysis discovered because of back pain, and he or she responds to treatment, there is no need to restrict activities as long as there is no pain. The chances of this developing into spondylolisthesis is indeed very small, with or without participation in sports. If your child has spondylolisthesis (slip), care needs to be exercised, especially in girls of young age. Up to the age of 14 or 15, the risk of further slip is the highest, and regular follow-up is needed. Sports participation is allowed, but strenuous sports like gymnastics, weight-lifting and football should be avoided. If surgery is needed, spine fusion is the procedure most often done, and results tend to be good.

NOTICE: The information presented is for your information only, and not a substitute for the medical advice of a qualified physician. The author nor the publisher will be responsible for any harm or injury resulting from interpretations of the materials in this article.

Rickey Dale Crain
IPF / WPC / AAU World Champion
York Barbell Hall of Fame / USPF Hall of Fame
CRAIN
3803 North Bryan Road
Shawnee, Oklahoma 74804 USA
405.275.3689
EST. 1978

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