Jo in Washington, USA, asks:
"Could you give me some idea of how long it takes for a stress fracture in the pars L5 to heal? My daughter has been out of soccer since 2/23 (3 months) and the Doctor said it may never heal. Does this happen? Is there any type of surgery that is commonly successful if it does not heal?"
Colin Natali, Consultant Spinal, Trauma and General Orthopaedic Surgeon at the back2normal back and neck clinic, London, replies:
"This is a significant problem and requires accurate diagnosis and treatment to be instituted.
"Pars fractures can be of several types depending on their region and can either be old or new. These types and the age of the fracture can be differentiated using specific tests such as a CT scan and bone scans.
"If the pars fracture is fresh and does not heal within 2 to 6 months consideration of a surgical pars fusion should be at least discussed. For old pars fractures (older than 6 months), there are typical features and treatment options are to rest patients from sports for up to 12 months until it hopefully heals, (which it often does not), or to proceed to a formal fusion.
"The starting point for all cases is an accurate history and examination. Tests including plain xrays, CT scans, bone scans and MRIs are useful. Treatment then starts with pain killers, physiotherapy and possibly injections BEFORE surgical options are discussed. The majority of patients do not end up having surgery, but it should be remembered that for most patients, simply reducing activities may reduce the level of pain to an acceptable level. This must be balanced with the options of surgery - which does not guarantee a return to high level sporting activities."