Spondylolysis is a lower back injury in children and adolescents that can cause pain in the lumbar area. This is typically an overuse injury that is seen in young athletes. Most commonly in gymnasts, divers, linebackers, and weightlifters who experience repetitive stress on the lower back. The lumbar vertebrae become fractured which causes pain that is usually worse when bending backwards. The fractured vertebrae can be seen on X-ray most of the time and usually involves the L4 or L5 vertebrae.
Treatment for Spondylolysis begins with rest from sports and strenuous activity. These patients are also treated in a TLSO brace with thigh cuff for 3 months. The brace is worn during the day and is only taken off for showers and sleeping to allow the fracture to heal. Patients are seen by Dr. Bradley in the office and the diagnosis is made by x-ray and examination, in some instances further imaging may be indicated. If a brace is indicated the patient will be sent to the Orthotist for measurements. Once the brace has been made the patient will begin wearing the brace as instructed.
The patient will have follow up appointments and activity will gradually be re-introduced into their daily activities. Once the fracture is healed the brace will be discontinued and the patient will be able to return to sports.
How is a cast put on?
First a stockinette (a special sock like material) is placed over the injured area to be casted. Then the area is wrapped with soft cotton. The plaster or fiberglass is then wrapped over the cotton and becomes hard when it dries.
Can a cast get wet?
Casts made out of plater can never get wet. Casts made from fiberglass have the option of being waterproof. The fiberglass can withstand getting wet and it is the liner inside the cast that can be made waterproof.
What do I need to know about waterproof casts?
It can take 6-7 hours the first two times you get it wet to dry completely. You have to drain the water out of the cast with certain positions for a long arm cast or a leg cast for 15-20 minutes. You can only get it wet in treated water, the swimming pool and a bathtub are ok. Do not get it wet in lakes, river or oceans.
This is the position to drain a short leg cast.
This is the position to drain a long arm cast:
What if my cast cant get wet?
You can buy a special sleeve at a drug store or online that will keep the cast dry. If you use a bag from home and some rubber bands then make sure not to submerge the cast.
Can my friends sign my cast?
Yes! They can draw all over your cast. Sharpies work the best. Make sure to pick up a gold or silver one if you pick a dark color for your cast. Get creative!
What if my cast is itchy?
If you have a waterproof cast then go ahead and submerge it in water. This will help the itching. You can also try a blow dryer on the cool setting. Do not try a pen, pencil or hanger. This can scratch the skin. Also, if the pen cap or eraser gets stuck in your cast, your cast needs to be removed right away!
What if the skin is red or raw around the cast?
The casting material is rough and can cut the skin. That’s why we put just the right amount of padding in between the cast and the skin. Children love to pick at the padding and pull it out. Don’t let them do this! If this happens we will make you a new cast.
Do all fractures need casts? (By the way fracture and break mean the same thing)
No, not all fractures need casts. A break in a collar bone or the top part of the shoulder can not be put in a cast. But good news is, a sling works great for these.
How is the cast taken off?
The cast is removed with a small electrical saw. The machine is loud and scary looking and can be very scary for some. The blade is small and dull and mostly just tickles if it touches the skin.
What will the skin look like when the cast comes off?
The skin will look pale, dry and flaky. If the cast was recently submerged in water there may be some waterlogged skin that takes an hour to dry. It is best not to scratch the skin with nails after because the skin is really sensitive after a cast. Sometimes the hair will be thicker and darker and the muscle may be smaller than it used to be. Don’t worry! This will all go back to normal.