One of my closest friends has had several back issues throughout her life. She used to be a competitive figure skater. For starters she has a history of a healed compound fracture of L-3 that was just diagnosed, which has caused some wedging of the vertebra. When she was eleven, she was diagnosed with scoliosis from L-3 through L-5 due to repetitive trauma to her growth plate of the left hip from her skating. The fifth lumbar vertebra is taking the same form of the sacrum causing what is called L-5 sacralization. (The image on the right shows an example of this.) And if matters couldn't get worse, she also has spina bifida occulta, which is where the spinous process on the inside of the vertebra is not closed properly. My friend is actually very lucky, because in some cases, spina bifida occulta can lead to huge deformities of the legs, feet (an example is clubfoot), and the spine making the patient unable to walk or walk without the use of a walking device. Throughout her whole life, she has had numerous MRI scans to monitor her condition.
What I found most interesting when talking with her, is that patients with spina bifida occulta can have several conditions that result from having this disorder. Some of these conditions are: UTI's, skin infections, and skin allergies.
She has tried several means of management to minimize pain and mazimize daily function. Initially, after the growth plate injury, she tried physical therapy with ultrasound and rest. She also was fitted for orthotic inserts to build her left side up to match the right so she doesn't walk crooked. Then she tried occupational therapy or "spinal re-training". She even had a cortisone injection under fluoroscopy, but unfortunately, it didn't help. Today, she uses a combination of chiropractic care, massage therapy, and a TENS unit (trans-cutaneous electro-neuromuscular stimulation). All of these treatments have helped tremendously with the pain and spasms, but she occasionally has to resort to using oral pain medication. Thankfully my friend has never had to have surgery, but some patients with these deformities have to undergo the knife, especially with severe cases of spina bifida occulta or growth plate trauma.
References:
www.ajronline.org
