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Surgery an option for recurring pars defect in 16 yr old youth pro soccer player?

Question: Surgery an option for recurring pars defect in 16 yr old youth pro soccer player?

My son first presented with the pars defect at L4 (bilateral) approximately 3 years ago. It took almost four months for a diagnosis at which point 4 months rest and then therapy were completed. He began playing again at a high level and six months later, the injury recurred, thus six months were taken off to heal and rehab and worked with his orthopedist to develop a maintenance program which he religiously follows to keep his core strong and flexible. He just returned from playing out of the country in a professional academy program for four months and had no issues. Due to his good play, he was just taken into an academy in Europe. After one week, he contacted us at home to say the pain was back and based upon his review of his symptoms (by now he's pretty familiar with what is and isn't the injury), he's convinced the injury has recurred. He's absolutely despondant that he'll be out again for another 4-6 months for the third time in just over three years. He presents no noteworthy slippage (he received a full work up with bone scan prior to leaving for Europe less than a month ago). He's fed up and wants to find some permanent surgical solution but we can't seem to find any documentation if surgery will allow for a permanent solution AND continuation of professional level athletic pursuits. Is surgery recommended an option to correct allowing for continuation of high level sports?

Answer:

Just a thought, but as a Podiatrist interested in musculoskeletal issues, I am always amazed at the the power of the lower limb and its effect on the entire posture. Issues of calf , hamstring, glutel flexibility, as well as pronation of the feet, can have a profounf effect on the alignment of the pelvis and hence the lower back. Repetitive issues will always point towards some sort of biomechanical stress.
Perhaps its time to think laterally, look for a cause not just the site of the problem.
Surgery....is always the option of last resort, and it does not necessarily deal with the mechanics, meaning that the forces at play may manifest further up the spine.