Newbie w/ spondylolysis seeking non-surgical options

[dsgny]

btw: this is an amazing forum. I've just spent several hours reading and learning.

15 yo athletic son has had 10 months of Left lower back pain. MRIs & xrays showed left spondylolysis in June, and now bilateral, complete fracture but still marrow edema (grade 3). Also disc herniation L5-S1. Was slight spondylolisthesis in June, but not seen on MRI of Oct.
He's been in a lumbar corset for 6 months and stopped playing competitively 10 months ago, and suspended all athletic activity 6 months ago. He's been recommended by one orthopedist for PLIF fusion.
We'd really like to find out what non-surgical options are available and are considering (1) cortico-steroid injections to reduce inflammation around pars defect (Might the spondylolysis heal?) (2) prolotherapy (3) sonocur shockwave therapy. Does anyone know if any of these might effective specifically for spondylolysis?
Are there any other options we should be considering?
If we end up with the surgery, we're also trying to understand the differences between TLIF & PLIF as different surgeons seem to recommend one or the other, either open or Minimally Invasive. Thanks so much. :Dani

[mmglobal]

Sorry you and your family are having to deal with this. I don't know how his age is involved in the surgical decision... I know that with scoliosis fusions they often wait until you are done growing. As always, you'll be weighing the risk of waiting versus the risk of juming in early.

Ask if there is no possibility of avoiding surgery, is it wise to inject stuff into your spine? I see injections as an effort to avoid surgery. While the risk is low, it is not zero, so as with so many things 'spine', LESS IS BETTER!

Note that these are questions... I'm not a doctor.

As far as prolo and other non surgical treatments... I believe that your son has a fracture, making the lowest part of his spine that is supporting his trunk and head, unstable. He's standing on a broken chair... will it get better or worse? You can paint the walls and wash the dishes, but it won't improve the broken chair.

Spine surgery is serious and the outcomes are not slam dunks. Make sure you know what kind of doctor and hospital you are dealing with... make sure your son is not your surgeon's first, fifth or twenty-fifth anything.

Good luck! Please keep us posted,

Mark

[dsgny]

Thank you greatly Mark. I've done LOTS of research on PubMed & GoogleScholar & GoogleBooks and through the National Library of Medicine of the NIH, the Pediatric Orthopedic Society of America, and the American Academy of Orthopaedic Surgeons, as well as on this site. I also have consulted formally with 2 orthopedic surgeons and 1 physiatrist and somewhat informally (although sharing the xray/mri reports and even showing the images) with other neurologist, orthopedist, and physical therapy friends, as well as 5 prolotherapy doctors (none of whom take any insurance).

The disturbing thing is that their recommendations are perfectly in line with their specialties and completely at odds with each other. The surgeons each said only surgery will solve the problem (and the one who uses PLIF explained why that's the best method while same for the TLIF practitioner) and that PT and prolo definitely wouldn't help; the prolo docs said that surgery and PT won't be necessary and that prolo will heal the connective tissue around the vertebrae and deal with the pain and then the body will heal itself; and the Physiatrists said prolo won't help, and please don't do surgery but 3 months of aggressive PT will almost certainly eliminate the pain and allow him to return to sports.

Orthopedists, Physiatrists, and Prolo doctors are all MDs but seem to have such different perspectives, especially on the value of corticosteroid injections, physical therapy, and prolo. In addition, they're very quick to order xrays and CTs without much thought to the possibility that this adolescent may end up with metal in his body and be unable to get MRIs in the future and so his radiation burden may be much greater than in others.

Now we're trying to figure out who to trust as we start investigating the research on Physical Therapy for spondylolysis/mild spondylolisthesis/disc issues. Thx again. ani