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L5/S1 Grade One Spondylolisthesis in Teenager

AnonymousUserAAnonymousUser Posts: 49,671
My 15 year old daughter has a lytic spondylolisthesis at L5/S1. She has had mid and lower back pain for over 18 months. This has not resolved despite rest and stopping gymnastics, ice skating and other sports. The MRI shows “multiple mature dorsal osteophytes anteriorly. The L5 vertebra is 2mm in front of S1. Disc shows borderline narrowing, but axials show no disc herniation.
A surgeon has suggested she have a Direct Pars Repair with “hook instrumentation” taking a bone graft from her vertabra and packing it in the fractures.

Would the above procedure be a good option? Why or why not?
If a pars repair is not likely to succeed, then which type of spinal fusion and what approach and instrumentation be the best option?

If she is still growing is surgery likely to fail?
Should she wait, or is it better to do the surgery right now to prevent a further slip?
Is it inevitable that the slip is likely to progress?

Should a Pars Repair be tried before doing a spinal fusion?

Please explain MRI results. Are the osteophytes abnormal?
Does anyone out there have a similar disorder or know someone with it?
Any help would be gratefully appreciated.

Thank you,



  • i also have spondy in the same place, hosp was hoping to do a repair of pars but my facet joints have osteoarthritis so they can only offer a fusion.
    depending where u live, i live in uk, the only fusion they do in my area is a 360 with cage and rods and screws, operating from front and back.
    your best bet is to talk to doc and see what he suggests is best way forward for your daughter.
    i wish they had found out what was wrong with me at a much earlier age. im 43 now.
    i personally feel if her quality of life is zero then she should go for fusion. only my opinion.
    good luck to you and your daughter, nice to see you giving her as much support and information as possible, feel free to ask me any questions, may not know the answers but good to talk to people with same conditions
  • I have a grade 4/5 slip. Probably have had some degree of slip all my life - first clearly recalled symptoms attributed to growth pains around 10. Diagnosed with spondy at 21. Now 37 w/no surgeries.

    The thing about surgeons is that like to do surgery. lol But seriously, recovery will likely be easier when your dd is younger. I would make sure she has a good support network whatever decision you go with. There are a couple of Yahoo! groups that are good, as well as these boards. Is your daughter's slip considered a grade 1?

    My advice - Get your daughter in to see 2-3 neurosurgeons and/or orthopedic surgeons and get their opinions.
  • Hi Windy,

    My daughter has had pain for over 18 months. She cannot participate in any sports. If she walks a long way her back hurts. Applying the brakes in the car causes her pain. The surgeon we saw is telling her she most likely will be able to return to gymnastics after a direct pars repair. She has a grade one slip at L5/S1 and a bulging disc. I read that a direct pars repair is most successful if there is no slip and above the level of L5. I am not sure about this. I am getting two other opinions. How bad is your back pain?

  • Sounds like your dd is in similar shape to where I am now. However, I had mild to moderate symptoms for most of my life. Your dd having this degree of pain and disability as a teenager would be an indication that more aggressive interventions may be needed. I cannot imagine a doctor advising a patient with a pars fusion and (even low grade)spondy slip to resume gymnastics. Keep in mind, too, that a fusion will take a year + to completely heal.

    I have had some bouts with severe pain and nerve involvement in the last three years. Unlike many people with spondy, I do well sitting on a hard chair. Standing or walking for more than 15-20 minutes really aggravates my back. Two to three years ago I went through a several month period where I could not lie down without shooting pains in my back and legs (like being shocked). That was my worst period, and I seriously considered surgery, but I did get way better with time. Mornings are difficult now - lots of pain, stiffness + nerve pain in leg.

    One thing I have learned over the years: degree of slip does not necessarily correlate with symptoms and degree of disability/impairment. I did well for years with a grade 3 slip. Many other people have disabling sx at a grade 1 or grade 2.

    Keep researching - your dd is lucky to have you.
  • In my opinion.She is only fifteen. Women grow till they are about 21. I would put this off for as long as possible because she still has six more years of growing to do. Younger people do heal better, but it is likely she will need more surgeries in the future. I have also heard that back surgery is the third most unnessecary surgery there is, so maybe get a second opinion. And most people dont have only one back surgery. Look on this board. Most people have had multiple surgeries on their back. So starting now might lead to alot more. Also any joint that has surgery is likely to develop arthrisis. With the new technology, maybe in a few years the could do something better. I know its painful but I dont want surgery either.
  • Hi Ashley,

    I am seeking two other opinions. My gut feeling is to wait to have the fusion and monitor her with lateral x-rays to see if the slip is worsening, or her daily life is severely disruptred. The main problem is the surgeon we saw gave her the impression that he would just "fix" her back and she would be back to gymnastics a few months later. He said that growth is usually finished by 15 and she would possibly grow slightly taller and that her spine would not be growing, but her legs. This and the fact that he said he did these direct repairs a couple of times a month makes me not trust him at all. Do you know how I can find out that she still has growing time and the success rate of direct pars repairs?

    I take in your advice and appreciate your input.

  • The MRI reveals that there is no disc herniation, but in addition to the spondy, she has some osteophytes growing --dorsal I think means on the upper edge and anteriorly refers to the "front" or interior side as opposed to the posterior, which would be the area closest to the skin of the back.

    Was this doctor suggesting your daughter could resume gymnastics if she had fusion? I do not see how that would be possible as a fusion takes away almost all extension in the spine. You can still bend forward and to the side, but anything like a back bend would be physically impossible (unless he knows some magical way to do it!!) There is some movement, but nothing like required in gymnastics, diving, ice skating, etc.

    Also, I hope you are seeing an orthopedic spinal surgeon as well as a neurosurgeon. I found that while the two specialties have very similar training, they tend to approach things with a slightly different perspective. I think it would be useful to see a doctor from each specialty.

    Also,you might want to look for a pediatric spinal specialist. He could tell about your daughter's growth and could better advise on surgery at this point.

    I remember a mom from a board I frequented several years ago who had a 14 year old who had problems similar to your daughter's. I'll see if I can find some old posts as the details are a bit fuzzy. I know the girl had a fusion and a year later was back to a fairly active lifestyle, including water skiing. I'm pretty sure she could not resume gymnastics though.

    xx Gwennie
  • His dr said he may never have a problem and he was diagnosed at 10
    Also has severe shnorls node.. His has never moved and he played bball... Did everything but football.
    He never had a problem.. 18 now and doing fine.

    I on the other hand had stage4/5 whichever it was a hair from severing my spine
    I had my first surgery at 14 .... U can read more on my signature
    But I would put off any fusion for as long as she can
    If I could show u my back it's the same size it was at 14 like it stopped growing
    And drs told me I was young and would heal fine which I did but the pain has never gone away. But the other problems that she may have going on should probly be looked at.
    Unlike when I had my surgery at14 my paents didn't seek second opinion.
    I had second opinion before my last surgery and took my son to a second opinion with my nerosurgeon. His first was a Nero at childrens hospital. Who I didn't care for after I had that mothers instict. He never did MRI on my son. And said his sponst was going back in place. That was not true .
    He had told me he had the shnorls node in part of his upper spine.
    My Nero did MRI and he had it all the way down his spine. I only have to take him in once a year to compare to the last year and nothing has changed and he is fine.

    Goodluck and at least when it comes to our kids get second opinion before a major back surgery....MY opinion.

  • Hi Hollie,

    I don't know how to read your signature so don't know what your diagnosis and treatments were.
    I don't understand what you meant about the doctor saying your son's sponst was going back in place. Thank you for your input.
    I am definitely having more opinions.
    I wish you and your son the best.

  • It was the first dr that diagnost him at age 10
    When he said that I had that mothers instinct to get 2nd opinion.
    First dr was pediatric nero the one he sees now is just a nerosurgeon... The one I use.
    I had grade 4 or 5 spondy that was a hair from severing my spine at age14
    But my sons has never slipped anymore and he's 18. I have takin him once a year just to keep an eye on it. The onlything he has complained about on occassion was hip feeling out of joint. And the dr showed him how to adjust it.I undid my signature cuz it was kinda rambling, I will repost it after I get correct terminalogy to be politically correct...LOL too many things going on.
    From reading your post sounds like the other things going on other than the spondy is the culprit... But I'm not a dr.

  • My son I were both born with this..... I just had a gut feeling to have both my kids checked and they found it in my son...
    And I know my torso quit growing after surgery and I did heal okay but have had problems since... Back then all they coud do was fusion.....After years of new pain I found out I had a fracture through my fusion,Aweful spurs in area,disc completely gone and it was bone on top of bone, which had nerves pitched paper thin as new surgeon described. I was 34 ( I think) and in emergency room kinda pain, when I went to this new dr that by the way saved my dads life so he had me from hello....anyways he was
    He was able to go in and clean all the old stuff out, jacked my spine up an inch and inserted 3 spacers,put rods with screws on each side and three fusions. I do have some nerve damage from the years being untreated but nothing like before and nothing that an ESI proceedure doesn't help. Have had 2 c-spine surgeries also but had nothing to do with lower back... Most definitely get a second opinion, and listen to her pain cuz she's the only one that knows what her body feels!!!!
    She will need your support and shoulder to cry on more than you can imagine.
    Good luck and keep me posted!
  • Hi Hollie,

    It sounds like your spondylolisthesis was so severe, you couldn't avoid surgery at 14. How scary. What level was your fusion at? Also, did you only have one fusion when you were 14? Where was the new fracture? You have been through hell! I hope you are o.k. now and have a decent life. My gut instinct tells me to avoid surgery on my daughter. I am there for her always. It's only natural. I have been through years of people not understanding the degree of my pain. I believe her about the pain and the effects it has on her life. She is tough, and wants to be so strong.
    What is an ESI procedure?
    I hope your son is o.k.

    All the best for you in the future.


  • The level back then was L4-S1. No other option but surgery. My new one I believe was L3-S1. And the fracture was right in the mid of first fusion.
    Esi is epidural spinal injection. You can search and get all the answers on it.
    I have good days and bad days, there are issues with my spine and I've had 2 C-spine surgeries on top of last back surgery. I live with chronic pain but am surviving.
    Good luck to you both and hope you find answers and relief.
    P.S. My son has was diagnosed at 10 and is 18 with no problems so far. He's very athletic and healthy!
  • Hi Hollie,

    I am sorry to hear you have been through so much. You have a good attitude though! I'm flad your son is doing so well!

  • Hey Charlotte.
    I'm sorry that your daughter is having to go through this at such a young age. I'm 24 and I just found out this past June I have Grade 1 Spondylolisthesis in my L5/S1 which is causing slippage and a herniated disc. I was born missing the pars and they found this on a simple x-ray taken at my doctor's office. From there I was sent for a MRI and was sent to see a neurosurgeon. The first neurosurgeon rubbed me the wrong way. I found a specialist in a bigger city a few hours from my house and he just made me feel more secure. He prescribed me 3 months of physical therapy and told me to try and lose weight and strengthen my body before coming back in October. He told me that my nerves are being pinched so severely that I would be doing my body more harm if I didn't have the back fusion done soon. My pain has increased A LOT since June. I am having to quit my job and stop a lot of the activities that I used to do. Sleeping is actually a hassle now. I'm dreading surgery, but if it stops this awful pain, it will all be worth it.

    Sorry..I'm rambling, but my suggestion would be to contact a few neurosurgeons. Get as much advice as you possibly can. If her pain isn't too severe, then maybe she can withstand having surgery for a few years, but I would hate for her to give up having fun in her last few years of high school. I'm having enough trouble facing this in college, I can't imagine what she's going through being in high school.

    Tell her she has a Spondy sister out here in Spine Health land and I will be thinking about her and I'm wishing her all the best. : ) Good luck to you too Charlotte. I know it has to be hard seeing your daughter hurt and not knowing what to do for her.
  • I was diagnosed around the same age, and for many years going to a chiropractor really helped my pain. It allowed me about 10 years of putting off surgery. Now I am 26, though, and the slip has progressed to a second degree with many neurological symptioms as well as pain. Sadly, surgery seems to be the only option. I would recommend trying conservative therapy like physical therapy, massage therapy, or chiropractic adjustments first. I also have a friend who gets the irritated nerves in her back cauterized to avoid getting the fusion. It works really well for her. Its a day or two of discomfort followed by 6-12 months of pain relief. You may want to ask if that is a option for your daughter. I do not know much about the cauterization procedure other than my friend swears by it. I hope you can sort through all the doctors and opinions and get the best option for your daughters condition.
  • We are going tomorrow afternoon to have my 16 year old CT looked at, they believe she has Spondylolisthesis I am unaware og the grade they have not mentioned it yet. They didn't give us much information other than her Cheer days are over, which is really hard for her to swallow. I have no idea what I need to ask other than what degree of slippage she has and how it will affect her later in life as well as, what types of physical activities she will be allowed to do from here on out. Any information would be appropriated as i am LOST right now trying to tread the waters I feel i am drowning in.
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