Possible stress fracture on the pars

[natoli]

My son just turn 12 and started feeling back pain in his right side lower back only when swinging a bat from the left side(he's a switch-hitter.)  I took him directly to a spine orthopedist Dr. He ordered a CT scan and a bone scan. I was almost sure he had spondylolysis (stress fracture on pars). To my surprise both tests came negative. So, Dr. ordered an MRI. MRI report says: L5-S1: marrow edema in the rigth pedicle and pars consistent with a stress fracture. CT correlation helpful.
Dr. says is only a stress reaction (no fracture) but he placed him in a brace for 6 weeks.
Son started feeling pain late April and the CT and bone scan were June 11. (7 weeks between first symptoms and the CT scan).
Somebody told me that it could be a fracture but that maybe we took the injury too soon to show fracture on the scans. Is that possible? Thanks!

[kittyluv1]

A pars stress fracture is not uncommon in a young person who is actively engaged in sports  which require repetitive movement involving bending and straightening of the spine.
The recommended treatment is bracing ( although some prefer no bracing and encourage muscle strengthening) and avoiding the specific movements that generated the stress response for 10-12 weeks.
It is possible that based on the findings on CT that a definite fracture event has not been identified, but the risk would appear higher if he continues to play sports without allowing sufficient rehab and strengthening the core muscles of the abdomen and lower back.
When the movement of rotation and extension can be performed without pain, slow return to sports activity can begin.  Changes in how your son performs his hitting (ie don't switch-hit) may be appropriate to reduce the risk of recurrent injury/complications.
It would be beneficial to have a sports physiologist or sports medicine evaluation and participation in a supervised therapy program to improve his conditioning.

[ruano5846]

Thanks!  Very well explained!  I'm resting him even before the first visit to the Dr. This was due to overtrain a young kid while having a growth spurt. In the future will modify training accordingly.