Fractures heal, while congenital abnormalities don't. How did this occur?
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A Young Student's Spinal Problems
Hello. I am a 16 year old attempting to get his athletic life back together. Since moving, I've been struggling to find some way to do my old sport of wrestling along with weight training.
An exceptionally disconcerting problem came along when I had my physical exams. Every reading from my examination was fine, except when the X-rays were taking. Apparently, there is a small case of tiny scoliosis, which wasn't the largest concern, because apparently there was a sign of a fracture on my back.
My doctor's final evaluation went something like this:
" Patient has a bilateral fracture of L-5 pars interarticularis with a grade I spondylisthesis. NO WRESTLING. Additional imaging such as a spect scan may be performed. "
Basically, there appears to be a small weakness in my back. I've been having some minor pains lately in the back, although it is not enough to leave me screaming in agony every time I come to pick up something off the floor. Rather, is is more of annoying, sore-like pain you get similarly to what happens after weightlifting.
What's rather unfortunate though, is that I'm not allowed to do any martial arts, wrestling included. As for weight training, my doctor recommends nothing that will aggravate my condition, squats included.
What happens now? Do squats actually kill off your back if you perform it correctly?
http://en.wikipedia.org/wiki/Pars_interarticularis
http://en.wikipedia.org/wiki/Spondylolisthesis
TMPHBITEU
Fractures heal, while congenital abnormalities don't. How did this occur?
Member
A spondylolytic spondylolisthesis is what you're describing. It is indeed a bilateral fracture of the pars interarticularis (posterior ring of the vertebra) allowing the body of the vertebra to translate forward. This happens most often under two circumstances, acute trauma and chronic degeneration. However, repetitive trauma to the pars will cause this as well. It's seen very often in female gymnasts.
A chronic degenerative spondylo is seen most oven in the population with the 4 F's. Fat Females over Forty at L Four. A traumatic spondylo is most commonly seen at L5.
Traumatic spondylo's go unnoticed a great many times. This happens frequently in children while they're still skeletally immature. Axial compression is one of the most common manners in which a spondylo will occur. Remember those child seats with wheels where the baby can bounce up and down repetitively while the parents can go about their business? I've got no proof that this contraption causes such a thing. But it just makes sense to me not to take a yet undeveloped spine and repetitively load it under axial compression. However, it's not entirely unlikely that you may have sustained the injury while wrestling as a younger child, with the only symptom being a sore low back for a few days. But that's just a guess based on what you've written here so far.
Anyway, I digress. Were lumbar flexion/extension xrays taken to determine if the spondylo is stable or unstable? An unstable spondylo with translate anterior and posterior during flexion extension while a stable spondylo will remain stationary. The stable spondylo usually has a cartilagenous bridge formed between the posterior ring and the body as an attempt to heal the fracture.
With a stable spondylo I would recommend caution with certain activites and avoid movements that place the lumbar spine in hyperextension. With an unstable spondyly I would restrict certain activities until stability has been achieved.
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What's been described is not uncommon in young athletes esp. in sports that involve significant extension of the lumbar spine: gymnastics, football, wrestling etc. A naturally hyperlordotic spine can predispose a person to this condition.
If had to guess, I would say the Dr.'s recommendation of restricted activity is based on the idea that it is an injury in process or "hot." This is what the SPECT scan would confirm. It is best not to do activities that would prolong the "hot" phase of the injury. The anterior displacement is more likely to advance during this stage-it makes sense to minimize this displacement.
That being said, once the body stabilizes the injury (it will remain displaced, but the body will make do), these restrictions should be reconsidered. For instance, there is a large percentage of NFL players with spondylolisthesis, many asymptomatic. In the endurance realm Lance Armstrong is probably the most notable "victim." The point being, your not on the permanent DL. I have seen significant displacement in entirely asymtomatic adults, the finding was incidental (as it appears to have been with you...What prompted Xray study on an adolescent boy in the absence of pain anyway? Was this a school sport screening physical or did you go to the Doc complaining of low back pain?)
Restarting SS training at a logical load and building progressively with solid form should not just be allowed but encouraged once the injury is "cold." A strong back (by the SS definitions and standards) is a stable back. I would absolutely recommend getting coaching on your lifts to scale them appropriately and to dial in your form. Take a trip Wichita Falls and spend some time getting it right or ask Mr. Rippetoe for a recommendation of a good coach near you.
Get the scan. If its cold, get started on getting strong. If its hot be patient, let that phase of healing happen, then get started on getting strong. Once you are strong, participate in whatever sport floats your boat.
Kevin Sandberg, D.C.
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I honestly don't recall any events. Apparently there was an event that either traumatized my back, or I was born with this abnormality.
If this was something I was born with, I don't see why I'm banned from doing martial arts or weightlifting. I've been doing fine these few other years.
TMPHBITEU
We now have an informed readership. Thanks Travis and Kevin.
Member
I'm no doctor, but based on unpleasant personal experience, the only doctor to trust with a spinal x-ray is a neurosurgeon. Not an orthopedist, not a neurologist, but a neurosurgeon. X-rays are all too often misread. If I hadn't told the orthopedist that I wasn't going to pay for his boat with my weekly insurance payments for weekly visits (he had 30 of them scheduled out) and demanded a consult with a neurosurgeon (I had to threaten a malpractice suit), I never would have gotten my commission because I had what an emergency room resident (and the "expert" orthopedist) misdiagnosed as a hairline compression wedge of T-5. It was just a misread x-ray.
Based on my experience, and the experience of friend of mine who was in a helo crash, trust no one with your spine short of a neurosurgeon. My two cents.
TMPHBITEU
An interesting perspective. Gentlemen?
Member
Well, I can only speak for myself and not for any of the other many thousands of doctors that are in practice at the moment.
The curriculum at my college includes 210 hours of Diagnositic Imaging, in addition to 60 hours of xray physics, 30 hours of xray positioning, and 30 hours of differential diagnosis. So, I am confident enough to say that I feel perfectly comfortable reading an xray and looking for significant pathology, fracture, etc.
However, I also have a good rapport with several doctors with advanced certifications in radiology. So I would not hesitate to send a patient's films out to them to have them read if I was unsure or wanted a second opinion.
Also, the history of the event will have a large amount to do with what is being looked for on a plain film. I very rarely have patients come into my office immediately post-trauma. And the patient's history will give me more information concerning cancerous tumors or other bone pathologies than anything else. Those things are confirmed on xray, usually not solely diagnosed by xray.
I am very sorry for your bad experience and I understand your position due to it. But just remember, in every specialty field, job and occupation, there are those that are good and bad. And nobody is infallible. It's not fair to judge the majority on the mistake of an individual.
Member
Based on my experience, and the experience of friend of mine who was in a helo crash, trust no one with your spine short of a neurosurgeon. My two cents.[/QUOTE]
Glad you found a good neurosurgeon. They are not, however, all created equal. This is true in any profession.Originally Posted by Mark Rippetoe
For example, there is an outstanding orthopedist in my area that I would send a family member to in a heartbeat. I have sent a number of patients to him that had found me first but really needed a surgeon. By contrast, in the town I first practiced in, the neurosurgeons were the ones to go to.
My question to you is what would you do if you went to a neurosurgeon with a problem and he said "you don't need surgery"? You are now a patient type he has limited interest in. He likes to do surgeries, God bless him. That's why he's a surgeon. Your kind of stuck if you don't trust any of those professions that are "short of a neurosurgeon." Especially since the majority of complaints you can expect to experience are non-surgical.
Kevin Sandberg, D.C.
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