Question
We just learned that my 16 year old son has a fracture of the L3 (Spondylolysis).  There is no sign of Spondylolisthesis and his discs are pristine. Two doctors have recommended a brace to see if the bone heals 3-4 months but say its only 10% chance that it heals without surgery.  We do not know when it occurred or if it is acute.Three questions: How likely is the bone to heal with bracing and bone stimulation? Can this fracture heal without bracing? What are the risks of the condition left uncorrected?  He obviously does not want to miss football and baseball but we want to do the best thing for him for the long term.
Thanks

Answer
As I'm sure you know, spondylolysis is a term used to describe a defect or break in the pars, the part of the bone that connect the spinous part to the body of the vertebra.

The cause(s) of a spondylolysis is felt to be repeated trauma, as in a stress fracture, to a pars that has been inherently weakened by hypoplasia or dysplasia of the pars, most often developmental. The most accepted documented reason for a spondylolysis in young children is torsional stresses or repeated trauma to a hypoplastic or dysplastic pars, ultimately causing a stress fracture. There are however instances when a single traumatic event will cause a spondylolysis.

Perhaps we are asking the wrong question here.  If the break is OLD, there's really not too much to worry about, go about your business.  If it's fresh, then it may be a tad disconcerting, as there may be an instability issue.   If it were me, that would be the question at hand... age.  The age of the break tells us a lot about the injury.  

Your son doesn't have this sliding of one bone on the other... so I initially wouldn't be that concerned.  Proper follow up dictates that you see the age of incidence.  Old, leave it alone, go about life as before.  New, consider the bracing.

I hope this helps, if you want to follow up please contact me via my website, www.dynamicclinic.com.

Dr. Peter Carr
Seattle, Washington