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Need advice, surgeon recommending pars repair for my 15 yr old

hotcoffee29hhotcoffee29 Posts: 327
edited 06/11/2012 - 8:41 AM in Back Surgery and Neck Surgery

After all my issues on my back and still having pain after my surgery I am paniced at the thought of my daughter having back surgery so young.

Gwennie, "C".......anyone, please help me sort out all my crazy thoughts, LOL

She has a pars fracture at L5-S1, has had meds, PT, rest etc, the injury is almost a year old and she is still in pain almost daily. She will be 15 next month. I took her back to the surgeon yesterday and at this point he said the only thing left to do is surgery, a fusion!!!! I thought no way a fusion, not now!!!

The he told me about a direct pars repair he can do with another surgeon in a big hospital in Tampa where they have ICU for pediatrics, he explained that they will put in hooks, and bone from her hip and a screw and with success it may put off a fusion surgery for many years to come.

I wouldn't even consider the surgery until the summer because I can't have her miss school, she would be kicked out of her vet academy. When we got home my husband was furious at the thought of surgery and said no way, he has seen me suffer since my surgery 6 months ago.

My daughter is so hurt, thinking we don't care, we don't understand her pain and she wants the surgery, ofcourse she is too young to understand the whole picture and we are trying to explain to her what a difficult decision this is, and how this can effect her future forever and may possibly lead to more surgeries down the road. Its a nightmare.

Please, any advice or anyone who has more information on this surgery please advise, I am trying to do research on this, so I am just at the beginning but I knew all my "spiney's" would be a great support system.

Thanks all,


  • I'm so sorry your family is going through this! It is so hard to see your child in pain! For men, they are fixers and protectors by nature, so I can understand your husbands point of view (he is just like mine) It is so hard for him to watch his wife in pain and suffering and he feels helpless to FIX it, but his daughter, that's unthinkable for him!

    With that being said, for your daughter's well being, it's best to take a step back and try to look at the situation objectively! I know it is a difficult surgery. But it has to be done. Kids heal so much faster and easier than we do. You don't want to take a chance on permanent nerve damage or creating a pain syndrome in her brain where the brain is so accustom to pain, that later when the real pain is gone, the brain continues to think it real and refuses to accept the pain ad being gone. It is a real syndrome and very difficult to stop.

    Can you imagine as a teenager being "locked"out of your body? Daily, I have to give up so much, family outtings, exercising, working, enjoying life, ever going out to dinner, all because of pain/weakness and falling without warning because my legs just go out. I can't imagine all of this as a teenager

    From the medical point of view~as a therapist working in rehab, we often had teenagers as patients and they did so well! Get 2nd, 3rd. 4th opinions, have several surgeons use her info as a case study. compare their opinions and remember, surgery is the last option and if it is recommended~it's because it is determined as medically necessary

    I hope this is helpfull! Let us know how things are going and what you and your husband choice to do!
  • I got to agree with jayhawk I really think you and your husband and daughter need to talk this out.But do get a 2nd and a 3rd opinions.

    You and your daughter will be in my prayers

  • Wow, what a predicament to be in. Can you seek out a second opinion by a surgeon who specializes in youth surgery?

    http://fos-society.com/annual06/4d.pdf Shows two case studies on children with Pars defects that underwent the surgery with hooks and rods vs fusion.

    It is difficult to move forward with surgery when our own personal experiences might not be what we would like or anticipate. When placed in the position to have to make this decision for someone else, that's not something most people would want to do.

    If I were in that predicament, I would try to research and evaluate the situation without bias from my own situation. A pars fracture is very different than a herniated disc, so can you really compare the two surgical outcomes?

    What did the doc say the long term prognosis would be if this was left unrepaired vs having it repaired?

    I really don't want to overstep my bounds in replying to this. I am not qualified to make recommendations one way or another. If it were my child, I would have difficulty seeing her in pain all the time and would have to weigh the consequences of both action and inaction in this matter.

    Sorry I'm not much help here.

  • I am so sorry you are going through all of this. I just had a l5s1 fusion due to spondelolisthesis due to bilateral pars defects at the l5 and s1.
    I am 46 now, at the age of about 25 I had to have a pre employment physical, the doc told me I "had a bone missing in my back" I thought he was crazy,(I knew nothing about the spine except that we had vertebra and was sure that if one of those was missing I would have known, I was single with 2 young children ages 4 and about 6 months) i found jobs that didn't require physicals.
    25 years later, fusion surgery that I have not been able to heal from due to nerve damage. I learned a great deal about the pars defects that some people are born with, one of mine had a great deal of cartilage that had filled in the space but could not provide stability, probably the original one seen at 25. My surgeon and his team felt strongly that I was born with it based on the size of the defect and the cartilage growth.
    My personal opinion is if you can get the pars defect fixed and avoid that slippage and possible nerve damage, that would be a blessing for your daughter in the long run.
    I am sure this is a difficult decision for you and your husband, get a second and third opinion, maybe even a fourth. You said your daughter wants to be a vet, I'm sure that will involve some heavy lifting, she needs her back as strong as possible.
    good luck,
    God bless and keep you at peace with your decisions.
  • Many prayers as you work through this decision. My thoughts are with you.

  • My prayers are with you.
    I understand both sides. You daughter wants to be a normal teenager. Your husband fears the surgery could make it tougher on her.

    I would definitely go for additional opinions.
    Several. Not just 2 or 3 but also see if you can find one that specializes in pediatric spinal injuries.

    I would also consider talking to a therapist to help everyone understand the pros/cons emotionally of the surgery vs. non surgery. IT's going to be a challenge either way...but perhaps a therapist can help you figure out what questions to ask.

    I agree with the other posters on their advice.
  • I truly, truly appreciate all the advice/prayers/opinions here, it does help, thank you all so much.

    It really is an agonizing decision, I do hate knowing she is in pain because I know how back pain feels, and my problems started much later in life.

    Her quality of life has changed as she did this injury last year playing soccer and now she can no longer play. She has gained weight and I know that does not help but alot of activities cause her pain. I have accommodations set in place for her at school so that she can get up and walk, sitting for prolonged times can really hurt her.

    Jayhawk, your right when you said trying to imagine being a teenager and being looked out of your body, I know what I have had to give up but we are adults, she is still a child.

    Yes, she wants to be a Vet and it is hard for her, she is involved in labs at school and they wash the dogs, trim nails etc, and the lifting and bending is painful for her.

    If I knew that surgery would truly help her pain and give her the chance to resume all activities I wouldn't hesitate however the Dr said it may or my not work but atleast we tried before requiring a fusion, if it fails she will need a fusion and then she will require another one in the future due to her age and there is the risk of the levels above having problems. He said the surgery for the pars repair has a higher success rate on levels higher up in the spine but hers is at L5-S1 and ofcourse thats the level that has the most stress on it.

    "C", you are correct, we cannot compare surgeries as the conditions are entirely different, so my outcome is what is making my husband so dead set against this surgery. I am going to check out the link you sent me.

    6 months ago her surgeon told us it is what it is, the injury had healed by itself and there was nothing more he could do, he told my daughter if it hurts, don't do it! Now here we are and she has pain all the time, right in that one spot (no leg pain as of yet) I feel I owe it to her to try to help her as much as we can, I just don't want her to have to suffer from multiple back surgeries startingat age 15.

    I will keep everyone posted, thank you all so much.

    Any thoughts on whether continued PT would be helpful for a pars fracture? She complains the exercises hurt!

    Best regards,

    We are just at the beginning of this, so I will seek out more opinions, I am not going to jump into this.
  • SpineAZSpineAZ WiscPosts: 1,084
    I think she needs to get a few opinions from a few adolescent spine specialists. If she was 19 or 20 I could see fusion as an option. But at her age I'd want to have adolescent spinal specialists giving opinions and also giving realistic short term and long term goals and limitations.

    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 

  • We, as parents, want to try to protect our children from pain and problems.

    I agree that you need to get more opinions and research all you can to educate yourselves on what this might mean for the future.

    I have a spondylolisthesis at L4/L5 and am about to have fusion surgery. I have been fighting against this for the last two years, but have now been told that I have severe compression on my cord and if I continue to try to avoid surgery, I will end up in a wheelchair and eventually with bowel and bladder problems. I am now 54 and am glad that I managed to live this far, without having to face surgery.

    My doctor is amazed that I managed to carry 3 pregnancies without being diagnosed. I did have a lot of trouble and pain with my back and sciatica, but I thought that is what happened when you were pregnant, and just lived with it. I have been told that when spondylolisthesis is diagnosed in young women, they are offered fusion because of the problems they are likely to have when pregnant, with the weight of the baby pulling forward on the spine.

    Your daughter is very young at 15 to have a fusion. It is a BIG surgery. Arm yourself with all the options you have and what each one will mean in the future. It may be that eventually, she will need surgery, but is there a chance to delay it? Or would it be best to go ahead and improve her life now? I don't know the answers to these questions, but there are people who can advise you; seek them out.

    Another thing that might help your decision is, whether it is stable or unstable. Sometimes they can slip further. Also, I believe that sometimes wearing a brace can be helpful.

    I think that you are about to become experts on spondylolisthesis!

    Prayers for your family, while you explore the options and make the decision as to what to do.

    Let us know how you get on. We are behind you and giving you 'cyber support'.
  • You are both correct, I do need to arm myself with lots of opinions and what the prospects are long term as thats what scares me the most, is this just the beginning of many surgeries in her spine starting at age 15! Thats horrible!!!

    She has no slippage at this point, which is great and no nerve damage or compression. however in order for her to resume normal activities this is always a possibility this will happen and the fracture healed without treatment because we did not know she had fractured her back!!! She was complaining of back pain after she fell at soccer but she hurt her ankle and was in a walking cast, I contributed the back pain to her being on crutches, after the ankle healed and she continued to complain of back pain, it was too late, we found he fracture but it healed on its own, with scar tissue, and we were told nothing could be done, no brace at this point could help, so she was told to take it easy, PT and see how it goes.....here we are a year later with constant pain!!! Not looking good.

    The only thing I can say her surgeon wants to do a direct pars repair befoe doing any fusion, he says he wouldn't be able to sleep at night if he gave her a fusion, he wants to try this surgery first, alot of other links I have read only talk of a fuion as the surgical "fix", the directs pars repair is somewhat contraversial, so this is why I really need to do my homework before i make any decision!!!

    Thanks for all your words of wisdom and support, I will be making her next appointment at All Childrens hospital.

  • I'm so sorry your family is going through this, will be keeping your family as well as your medical team in my prayers. Another thought might be to research pediatric spinal specialists and determine where in the US the top specialist/medical center might be for pediatric spinal specialists. Your insurance may cover the cost of going were the specialists are. If not, Ronald McDonald house may allow your to stay at one of their locations. Where there is a will, there is a way. There are many charity organizations to help get her to the specialist/specialized med center (and it is easrly in the year so there are charitable dollars avaliable).Throughout the years as I therapist, I have helped many families to find the specialists they need (my specialty is working exclusively with babies from birth to 3 years). I will ask around to see if I can help find where to go~if you can't get there, they may be willing to do a case study with her records and copies of her MRI's ect. We are here to help and support you!
  • I have been learning quite a bit about spondylolisis this weekend! I am going to get her an appointment at All Chilrens Hospital in St Pete as my next opinion and I have another doctor from Tampa general willing to look at her. I am trying to educate my husband in all this as we outweigh the pros and cons for our daughter, he still thinks surgery is the last thing we should consider and if I thought she could live with this and her condition would not get worse I would leave it alone, but I think we do have to continue to do our homework and get many opinions before we make a decision. I don't want a fusion to be done on her, I just feel she is way too young for that, but if a pars repair can be done successfully I do think its worth looking into.

    Thanks so much to everyone for all the support, it has been so helpful to me. I am truly greatful.

    God bless,
  • I know what you are going through with your daughter. My daughter was in the car with me last April but didn't have any significant complaints at that time. THen in September she started complaining of neck and shoulder pain.

    It is soo hard when they are in pain and you can't fix it. I've been on a 4 month merry-go-round of doctors and pt with her while dealing with my own treatments and surgery. My daughter has missed over 30 days of school so far this year due to her complaints. Thank goodness she is a great student and has stayed on honor roll.

    The frustration of appointments and tests and differing information is more than any person should have to handle and much worse for a parent. Many years ago my husband and I had to make the decision for my son to have surgery when he was 3 years old(he's almost 17). Most people including our pediatrician thought we were crazy to put him through surgery then so he would not have severe hammer toes later in life like me. It was the right decision and a complete success!! But at that time I agonized for weeks.

    No one said being a parent would be easy. But I also believe you find the strength to handle what needs to be done. Remind your husband that ignoring the problem is not finding a solution. Together you can do what needs to be done.
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