low back pain, how common is the dreaded pars fracture?

[Eric F]

If you feel like you need a second opinion, get one. Do what you need to do to take the best course of action for your DD's recovery.

 

[Me_and_my_big_mouth]

OK so we saw the Ortho Doc, and I beyond confused. Think I will be seeking a 2nd opinion. MRI report reads: Prominent marrow edema within the left L4 pedicle, slight marrow edema in the right pedicle of L4. This marrow edema left greater than right shows no bone expansion or destruction or adjacent soft tissue mass and there is no evidence of L4 spondylosis. The edema is considered benign and most likely represents a stress response.
At L5-S1 the findings are unremarkable except that there may be subtle or early bilateral spondylolysis.
Ortho Doc, says there is a stress response at L4 (he showed it to me on MRI). He recommends a brace for 6-8 weeks and physical therapy thereafter with a plan to return to the field in 3 months.
He seems to think her pain has nothing to do with the stress fracture and possibly comes from getting hit by the pitch. he also disputes that there is any abnormality at L5.
None of this is making much sense to me right now. Stick

I am not a doctor, but saying there may be early bilateral spondy sounds like enough reason to pursue a second opinion. As I understand it, the most common area of injury is L5 - S1. And maybe you have a situation where the hit by pitch injury actually exacerbated the fracture and now you've found it, so possibly ortho doc is seeing the soft tissue injury in L4 and discounting what's happening in L5?

http://emedicine.medscape.com/article/95848-overview

Did you he give you a reason for disputing the findings of abnormality at L5? And is this a sports med ortho?

 

[stickpile39]

I am not a doctor, but saying there may be early bilateral spondy sounds like enough reason to pursue a second opinion. As I understand it, the most common area of injury is L5 - S1. And maybe you have a situation where the hit by pitch injury actually exacerbated the fracture and now you've found it, so possibly ortho doc is seeing the soft tissue injury in L4 and discounting what's happening in L5?

Medscape: Medscape Access

Did you he give you a reason for disputing the findings of abnormality at L5? And is this a sports med ortho?

You make a good point. 2nd opinion will be investigated. he is a sports med doc but he disputes the MRI findings at L4 and L5, so I need to get it figured out. He also said he would not image again, so how would we know if she is ready to get back to activity? Seems an odd approach to say the least.

 

[Dial]

Stick,

Sorry to hear the diagnosis. Get the second opinion if you feel uncomfortable. Ask for the bone scan as well. Ours did both on the same day. That might be considered a SPECT?? Still trying to get all the medical jargon down.

 

[stickpile39]

Did you he give you a reason for disputing the findings of abnormality at L5? And is this a sports med ortho?

said 6% of the population has this finding not significant without edema

 

[stickpile39]

Stick,

Sorry to hear the diagnosis. Get the second opinion if you feel uncomfortable. Ask for the bone scan as well. Ours did both on the same day. That might be considered a SPECT?? Still trying to get all the medical jargon down.

Thanks Dial would this be better than MRI?, or would another future MRI be good to compare progress?

 

[Me_and_my_big_mouth]

said 6% of the population has this finding not significant without edema

But your daughter IS IN PAIN. Man, this is frustrating.

The primary consideration for any course of treatment is first pain management and second recovery. Rest is the surefire way to accomplish both, regardless of how the pros choose to argue about it, IMHO.

Sit her. At least 2 weeks, zero activity, then re-evaluate if that seems warranted. If she still has pain after 2 weeks, sit more.

I emailed you a book.

http://radsource.us/spondylolisthesis-spondylolysis/

Sent from my SM-N910V using Tapatalk

 

[RubberBiscuit]

So sorry to hear this situation stick - it hits sooo close to my heart - even after all the years gone by.

My 2 cents =>

Don't go see another doctor. Trust the one who has seen the most pitchers & football linemen in their sports injury Ortho doctor career (which sounds like the one ya got the diagnosis from). We had exactly the same scenario where our younger sports orthopedic doctor, who cared for the UW Madison pitchers and football team directly, said we should go see the almighty "senior" ortho surgeon in the UW medical system hierarchy. Well this nationally renowned senior ortho surgeon was just a bad distraction and he recommended surgery too (talking specifically to pars break now). I think some "senior & out of the focus of pitchers injuries" experts get very distracted from the peculiarities of a young body pitchers pars injury.

There are no shortcuts in the recovery to this. Ya have to accept and move forward to the next step of the process. The faster you move to the next stage of this the better.

 

[stickpile39]

So sorry to hear this situation stick - it hits sooo close to my heart - even after all the years gone by.

My 2 cents =>

Don't go see another doctor. Trust the one who has seen the most pitchers & football linemen in their sports injury Ortho doctor career (which sounds like the one ya got the diagnosis from). We had exactly the same scenario where our younger sports orthopedic doctor, who cared for the UW Madison pitchers and football team directly, said we should go see the almighty "senior" ortho surgeon in the UW medical system hierarchy. Well this nationally renowned senior ortho surgeon was just a bad distraction and he recommended surgery too (talking specifically to pars break now). I think some "senior & out of the focus of pitchers injuries" experts get very distracted from the peculiarities of a young body pitchers pars injury.

There are no shortcuts in the recovery to this. Ya have to accept and move forward to the next step of the process. The faster you move to the next stage of this the better.

Rubber, thanks for weighing in again. Trust me when I tell you, I am not looking for shortcuts to the healing process, concern #1 is DD's long term health. With that said, we need another opinion. The doc and the radiographer are interpreting this MRI vastly differently. "If" she has a stress reaction and not a true break which at this point I don't even know, there would be some disagreement about whether to brace or not. Most importantly why we need a 2nd opinion, is this doc said straight out he will not order additional imaging. I will not feel comfortable with DD getting back to any kind of activity without some evidence of healing.

 

[stickpile39]

Thanks again Me_and_my...