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Sunday, March 9, 2014
Spine and Back Health
L-4 pedicle fracure / treatment
My son (17 year-old baseball pitcher, right handed pitcher) has just been diagnosed after an MRI with an L-4 right pedicle stress fracture where the pedicle meets the vertebral body, no displacement. I know these fractures are rare. What is the best treatment? I think he needs a brace which prevents rotation. Our ortho doesn`t seem to know. What are the odds of this healing and him pitching again? Serious pain started 10 weeks ago. Minor pain started a year ago.
Hello, thank you for your question. Yes, these fractures are quite rare. The "best" treatment is not well defined; in most cases where there are stress fractures of both pedicles (left and right in the same vertebra) the injury is thought to be unstable, and has usually been treated with surgical fusion and hardware (screws and rods to stabilize the vertebra).
Unilateral (one side only) pedicle stress fractures are much less common, and it's unclear what the best treatment is. One option is an initial period of rest, no strenuous activity, for about 6-8 weeks, followed by gradual physiotherapy and rehab. If this fails to result in pain relief, some people resort to surgery. This can now be done minimally invasively, as an outpatient surgery, with a single very small "stab incision" about ¼ inch long to place a single bone screw directly through the fractured pedicle. In such cases, fusing the vertebra to the adjacent vertebrae is unnecessary, and usually allows return to full normal function once the person heals from the surgery. I hope this helps. Good luck.
David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University