Case Reports
. 2021 Jun 16;9(17):4408-4414.
doi: 10.12998/wjcc.v9.i17.4408.
Affiliations
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Case Reports
World J Clin Cases.
.
Abstract
Background:
Four-level lumbar spondylolysis is extremely rare. So far, only 1 case has been reported in the literature.
Case summary:
A 19-year-old man presented with severe back pain irresponsive to conservative therapies for 2 years. Lumbar radiographs and two-dimensional computed tomography scan showed four segment lumbar spondylolysis on both sides of L2-L5. Lumbar magnetic resonance imaging showed normal signal in all lumbar discs. Because daily activities were severely limited, surgery was recommended for the case. The patient underwent four-level bilateral isthmic repair at L2-L5. During surgery, L2-L5 isthmi were curetted bilaterally, freshened, and then grafted with autologous iliac bone that was bridged and compressed with a pedicular screw connected to a sub-laminar hook by a short rod. The symptoms of back pain almost disappeared. He has been followed-up for 96 mo, and his symptoms have never recurred. Fusion was found in all repaired isthmi 14 mo after surgery according to evaluation of lumbar radiography and computed tomography scan.
Conclusion:
We report here 1 case of four-level lumbar spondylolysis that was treated successfully with direct isthmic repair.
Keywords:
Case report; Isthmic repair; Lumbar spondylolysis; Pedicle screw-hook system.
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Conflict of interest statement
Conflict-of-interest statement: The authors declare that they have no current financial arrangement or affiliation with any organization that may have a direct influence on their work.
Figures
Figure 1
Lumbar radiographs. A: Anteroposterior radiograph; B: Lateral radiograph showed L2-L5 spondylolysis; C: Lateral radiograph of lumbar extension position; D: Lateral radiograph of lumbar flexion position. Note that lumbar dynamic radiographs showed no instability.
Figure 2
Two-dimensional computed tomography scan shows lumbar spondylolysis at bilateral L2-L5 levels.
Figure 3
Magnetic resonance imaging showed no signs of lumbar disc degeneration.
Figure 4
Lumbar dynamic radiographs after operation showed that lumbar movement was retained. A: Anteroposterior radiograph; B: Lateral radiograph; C: Lateral radiograph of lumbar extension position; D: Lateral radiograph of lumbar flexion position. Note that lumbar dynamic radiographs show that movement was retained.
Figure 5
Computed tomography scan showed bone healing in all eight lytic defects at L2-L5. A: L2; B: L3; C: L4; D: L5.
Figure 6
Donor site of iliac crest was filled with allogeneic bone, which resulted in osteogenesis (arrow).
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