Introduction:

The term “pediculolysis” encompasses rare, chronic pedicular changes characterized by pedicle hypertrophy, sclerosis and pseudoarthrosis, which develop secondary to recurrent micro-fractures following repeated stress injuries. These stress injuries to pedicles may be insufficiency fractures, commonly reported in elderly patients with associated osteoporosis or fatigue fractures occurring in young adolescents involved in heavy sports. These pedicular lesions have been reported in association with defects in other components of neural arch including pars inter-articularis and lamina.

Case report:

We hereby describe a rare case of grade 1 spondylolisthesis with left-sided pediculolysis and contralateral pars lysis in a middle-aged female patient without associated osteoporosis or co-morbidities. She underwent L5-S1 trans-foraminal lumbar interbody fusion (TLIF) after failed, initial conservative measures. However, her symptoms were persistent even after the surgery, which necessitated revision surgery involving left L5 medial pediculectomy, neurolysis of left L5 nerve root and extension of instrumentation to L4 bilaterally and L4-5 postero-lateral fusion.

Conclusion:

We report this case in order to bring into the awareness of spine surgeons regarding the existence of this rare entity even in middle-aged individuals. Based on our experience with this patient, we believe that in patients with L5 pediculolysis and spondylolisthesis, the option of L5 medial pediculectomy and extension of instrumentation to L4 level should be considered.