BACK PAIN - SOCCER PLAYER

Abstract

HISTORY A 19 y/o collegiate soccer player presented with a two week hx of activity-related non-traumatic low back pain. The patient subsequently had imaging to include plain films, SPECT bone scan and fine-cut CT, which established the dx of a unilateral spondylolysis involving the left L5 pars. He was treated with initial activity modification, 6 weeks in an LSO, an advanced LS stabilization program. At the 4 month mark, he had advanced to be pain free with ADLs and was active in light activity; he requested the green light to return to soccer. A repeat fine-cut scan at this time demonstrated no significant evidence of bony healing. PHYSICAL EXAMINATION Normal to inspection with no abnormal curvature noted. Normal range of motion. Nontender to palpation. No step-off noted. Negative single-leg hyperextension testing. DIFFERENTIAL DIAGNOSIS L5 spondylolysis – clinically healed/fibrous union L5 spondylolysis – clinically healed/bony non-union TEST AND RESULTS CT Scan (4 months into therapy, 5 months out from initial activity modification) – spondylolysis of the pars interarticularis of L5 on the left with hazy fracture lucency and abbutting sclerosis suggesting long chronicity; no significant interval healing. FINAL/WORKING DIAGNOSIS L5 spondylolysis – bony non-union TREATMENT AND OUTCOMES Initiation of 4 month treatment course with bone stimulator; 24 hrs/day. Continued LS stabilization. Aqua jogging for two months followed by graduated land running for two months. Follow-up CT at 4 months with significant bony healing demonstrated. Continued bone stimulator thru 6 months; follow-up CT scan with demonstrated bony union. Returns successfully to collegiate soccer as a starter.