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Lower back pain. CT scan confirmed no fracture. What could be the reason?

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Spine Surgeon
Practicing since : 1998
Answered : 116 Questions
Hi, my daughter is a 13 almost 14 year old gymnast. She had lower back pain and X-ray showed nothing. However, an MRI showed marrow edema by the L5 along the pedicle and pars and no fracture. A CT scan confirmed no fracture at the site. She went to 3 different doctors and was told 3 different things. The first sports medicine doctor didn't think it was anything much since she passed all the usuall test for spondylolysis and said a few weeks of rest and she was good to go. The second doctor who actually did the MRI, the first only did Xray, said stay out of the gym for one month. Well, being extremely high level and competition season around the corner, I tried one more through a referral to see if there was anything she could still do. The doctor gave her a soft brace and had her in the gym but she must wear the brace while performing skills. So far she hasn't been wearing it as much as she should, however, with the skills she is doing, she has no pain at all. Everything on the internet points to active spondylolysis and being braced for 3 months. I am very confused and wonder if she has no pain is it ok to proceed with what she is doing.
Posted Sun, 10 Nov 2013 in Back Pain
Answered by Dr. S K Mishra 1 hour later
Brief Answer:
If there is no listhesis you should not worry

Detailed Answer:
Thanks for query,

Points you mentioned are
Xray normal
CT scan conformed no fracture
while MRI showed only edema of pars ,
she has received few weeks of rest and
now she is pain free.

One thing you have not specified is about Xray Lumbosacral spine lateral view in flexion and extension. If it has been done and was normal it is OK ie does not show any listhesis (slippage of one vertebra over other),otherwise do it.

If there is no listhesis you should not worry much and only such marrow edema usually heals in 6 weeks and this period is enough.

Since there was no fracture so 3 month months waiting is not required , however you may wait for 3 months if you are not clear.

Hope I was able to answer your query.
Above answer was peer-reviewed by
Follow-up: Lower back pain. CT scan confirmed no fracture. What could be the reason? 1 hour later
Thank you. The X-ray was done in the way you mentioned to my understanding. It showed nothing, as did ct scan.

The MRI report mentioned retrolisthesis but the three doctors who reviewed it didn't even address it.

Here's the exact wording:
the first axial T2 image defines the mid-body of L1. On the sagital images, now significant dic desiccation or loss of intervertebral disc height. retrolisthesis of L5 on S1. Bone marrow signal normal. The conus medullaris terminates at a normal anatomic level.

There is no high grade central canal narrowing or disc herniation on sagittal images through the visualized lower thoracic spine.

At L1-L2, L2-L3, L3-L4, L4-L5 no significant spondyloarthoropathy.

At L5-S1 bone marrow edema present along right pedicle and pars. Central canal and neural forman preserved.

Again, not one of the three doctors even mentioned the retrolisthesis after looking at the mri, only mentioned in report.

Does this changes things?

Answered by Dr. S K Mishra 22 minutes later
Brief Answer:
Consult a spine surgeon/specialist

Detailed Answer:

Thank you for writing back.

If MRI shows listhesis, Xray Lumbosacral spine lateral view in flexion and in extension should not be normal. In that case, either this particular Xray is not done or one of the reports is not correct.

However nontraumatic retrolisthesis sometimes occurs as a result of degeneration.

Since your daughter is gymanst you should consult a spine surgeon/specialist.

You may upload pictures of dynamic(flexion/extension) Xray and MRI too.

Hope this answers your query. Please do write back if you need any clarifications.

Wishing your daughter a speedy recovery.


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