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L5/S1 Grade One Spondylolisthesis in Teenager

AnonymousUserAAnonymousUser Posts: 49,578
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.
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  • 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.
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  • 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.

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