Uploaded byRobert Pashman
Case Review #A: Major League Baseball Player has a Spinal Fusion
The document details the case of a 25-year-old major league baseball player diagnosed with multiple pars and pedicle fractures in the lumbar spine after experiencing back pain due to pitching. Conservative treatments failed, leading to a proposed surgical strategy involving laminotomy, spinal fixation, and fusion to address the fractures and alleviate nerve root entrapment. The player has additional comorbidities and underwent thorough imaging to guide the surgical approach.
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Case Review #A: Major League Baseball Player has a Spinal Fusion
- 1. Pars/Pedicle Fractures ina Professional Major League Baseball Player Robert S Pashman, MD Scoliosis and Spinal Deformity Surgery www.eSpine.com
- 2. Patient History 25 yearold Right handed starter brought up from minors After 1st major league start began having back pain Pitch mechanics changed, back pain increased No radiculopathy Exhaustive core rehabilitation MRI no disc herniations or advanced degeneration CT Spect positive L3 and L5 CT scan
- 3. Lumbar Scout Views: NoSpondylolisthesis
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- 5. L3: Right PedicleFracture Left Pars Fracture RL L3 L3
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- 7. L5: Right ParsFracture, Left Pars Fracture RL L5 L5
- 8. Indications for Surgery Parsinterarticularis fracture, L5-S1 on the left. Pedicles pars fracture, L5-S1 on the right. Pars interarticularis fracture, L3 on the left. Pedicle fracture, L3 on the right. Left-sided low back pain due to the above diagnosis. He has multiple comorbidities including flat feet, hypersensibility of the elbows. Semi-professional baseball player. Failed conservative therapy.
- 9. Spine Surgery Strategy? L5 •L2 no fracture • L3 R pedicle L Pars fracture • L4 no fracture • L5 Bilateral Pars fracture • No Spondylolisthesis
- 10. Surgical Strategy 1. Interlaminarlaminotomy medial facetectomy, lateral recess release, L5-S1, for removal of a pars interarticularis healing callus with nerve root entrapment, L5-S1 bilaterally. 2. Segmental spinal instrumentation L5 for repair of pars interarticularis fracture, L5-S1 on the left. 3. Open reduction and internal fixation pedicle fracture and pars interarticularis fracture, L5 on the right. 4. Posterior fusion L5-S1 with combination of locally harvested autogenous bone and RH BMP for open reduction and internal fixation L5 bilaterally. 5. Intraoperative SSEP's. 6. Intraoperative fluoro management.
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