Acute L5 pedicle fracture and contralateral spondylolysis in a 12-year-old boy: a case report

Abstract

Acute unilateral L5 pedicle fracture associated with a pre-existing contralateral spondylolysis is a rare lesion. We report a case in a non-competitive 12-year-old boy. We present the clinical, radiological and specific management of this rare condition. The clinical and radiological draft of this patient was reviewed. The followup was 30 months after fracture healing. Some cases reported in the literature were analyzed and our clinical findings and therapeutic strategy was compared and discussed. Non-operative treatment was done including fulltime bracing in a modified Boston brace incorporating one thigh for 3 months. Plain radiographs and computed tomographic (CT)-scan performed at 3 and 6 months showed progressive healing of the pedicle fracture and no modification of the contralateral isthmic spondylolytic lesion. At final follow-up, the patient was asymptomatic and resumed all his activities. In skeletally immature patients, we think that conservative treatment should be considered as a treatment option for this unusual injury.

Posterior osteosynthesis of a spontaneous bilateral pedicle fracture of the lumbar spine

“…Some cases of unilateral lumbar pedicle fractures related to contralateral spondylolysis 3,6,7,22,23 or following surgical fusion have been reported. 8,11,12,15,18,19,21 However, reports of bilateral pedicle fractures without significant trauma, surgery, or a bony abnormality are limited.…”

Symptomatic Unilateral Spondylolysis Associated with Non-Spodylolytic Lateral Clefts in Adults – Guidelines for a Rare Condition

“…Scintigraphy is another modality which can indicate the acuteness of the lesion [13]. Active reparative mechanism within the lesions may be demonstrated by enhanced uptake in the pedicle marrow.…”

“…A trial of conservative treatment for a period of three to six months (including relative rest and abstinence from sports activities) should definitely be considered in these individuals before any option of surgical intervention is conceived upon. Some authors also advocate lumbar bracing to enhance healing [13]. Conservative management with orthosis and concomitant anti-osteoporotic medical therapy has also been successfully employed in the management of acute, osteoporotic pedicle fractures [10].…”

“…These patients, when symptomatic definitely need to undergo surgical intervention for healing of bony defects [13,14]. The surgical options described in literature for such lesions include direct repair of the lytic lesion [2][3][4][5][6][7][8][9][10][11][12][13][14][15], postero-lateral fusion, trans-foraminal or posterior lumbar interbody fusion (single or double level TLIF or PLIF) [10].…”

“…The surgical options described in literature for such lesions include direct repair of the lytic lesion [2][3][4][5][6][7][8][9][10][11][12][13][14][15], postero-lateral fusion, trans-foraminal or posterior lumbar interbody fusion (single or double level TLIF or PLIF) [10]. In young athletes with chronic pediculolysis without evidence of intervertebral instability, direct repair of the pedicular cleft using compression screws has been described as a treatment option [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Such motion-preserving surgeries may obviate the need for segmental fusion procedures in patients with high physical activity.…”