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Suggest Treatment For Pain After Trauma Resulting In Bony Injury

Posted on Fri, 23 May 2014

Question: Hi I am 36 years Male, A recent mountain biking fall resulted in Pain attended ED and an abnormal xray resulted in a CT being performed: The reults are Defect of the Left Lateral Pars of L4 which is longstanding, minimal anterolisthesis on L4-L5 and some calcification posterior to the spinous process of L3. I think the trauma has aggravated long standing degeneration that I want aware of. I am still in much pain despiste Strong analgesia should I be concerned

Answered by Dr. Indu Kumar (27 minutes later)

Brief Answer:
You need MRI L/S Spine.

Detailed Answer:
Hello XXXXXX
Thanks for writing to us

It is important to know status of intervertebral disc and nerve status in your case.
CT scan is ideal for bony injury,which shows mild spondylotic changes in lumbar spine.Mentioned bony changes can be managed conservatively.
Main concern is intervertebral disc and nerve status which can only be accurately assessed by MRI L/S Spine,so you should go for it.

Muscle spasm may be the reason for severe acute pain.You need absolute bed rest for at least three days.
Deep ultrasound heat wave therapy and TENS(Trans cutaneous electric nerve stimulation)will give immediate relief.
Hot fomentation should also be done at least four times daily.

You can take capsule pregabalin for pain relief along with muscle relaxants like tablet Tizanidine.

You should avoid lifting heavy objects.

Get well soon.
Hope I have answered your question.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (1 hour later)

Thank you for you answer, I understand the Pars defect and the minimal anterolisthesis are common. The fall I had was over two weeks ago, the doctor has PX me Codeine 60 QDS paracetamol 1g QDS Ibuprofen and Diazepam 5mg PRN. the muscle spasm I have has almost gone however I am getting constant pain radiating from L spine through thighs into my knees, my right testicle is also constantly painful. Do you think the calcification could be the cause and is it normal to have calcification L3 as I am only 36?

I have a OPA at the fracture clinic in one week and will ask him for an MRI. Thank you in advance for your time and advise

Kind regards
XXXXXXX

Answered by Dr. Indu Kumar (44 minutes later)

Brief Answer:
Please find detail answer below.

Detailed Answer:
Hello XXXXXXX
Thanks for writing back

Your symptoms strongly suggest neurological component,so MRI L/S spine should be done.
Calcification doesn't cause pain.It is the part of degenerative changes,this is early in your case.

Get well soon.
Hope I have answered your question.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar