Alleviation of Chronic Low Back Pain due to Bilateral Traumatic L4 Pars Interarticularis Fractures Relieved With Steroid Injections

Abstract

Chronic back pain affects 20% of the adult population in the United States and is a significant source of disability and healthcare expenditure. One of the most common causes of chronic back pain is spondylosis. These changes result from age-related degeneration of the lumbar spine. As a result of this degeneration, spondylolisthesis can develop. Spondylolysis is a fracture of the pars interarticularis. It affects younger patients and is more prevalent in adolescents and elite athletes. It can be a debilitating condition that may force athletes into retirement as well as impair them with chronic pain and disability. Traditional treatment options include conservative management such as medications, rest, physical therapy, and rehabilitation. Surgery is reserved for patients who do not respond to conservative measures. Here we present the case of a 39-year-old mixed martial arts fighter with bilateral L4 pars interarticularis fractures and chronic low back pain. After failing conservative treatment options, this patient finally obtained significant relief with steroid injections at the level of the defect. The patient continues to do well with occasional injections and is able to maintain his mixed martial arts career. This case report provides evidence that injection therapy is a feasible alternative to surgery in patients who fail conservative therapy.

Main and contralateral side stages of lesion affected bone union in the conservative treatment of adolescent lumbar spondylolysis: a multivariable analysis of 217 patients and 298 lesions in a retrospective cohort study

“…In lesions that are expected to have a particularly low rate of bone union as they have many negative factors for bone union, if conservative treatment failed to achieve bone union, pain control with oral painkillers or interventional pain injections, early surgery due to pain, or repair surgery for lesions that became pseudoarthrosis may be effective depending on age and sports level [ 6 – 8 , 22 – 25 ]. To further develop the treatment of lumbar spondylolysis, prospective studies on the ability to predict the rate of bone union at the time of the initial visit are a future prospect and challenge.…”

Back pain in adolescent athletes: a narrative review

“…[39][40][41] Intradiscal steroid injection or transforaminal steroid injection may offer therapeutic benefits to adolescents with inflammatory low back pain; however, it has only been extensively studied in adults and requires further study in the pediatric population. 9,42,43 Patients diagnosed with herniated disc alongside a chief complaint of leg pain (rather than back pain), positive straight leg test, and a soft protruded disc may seek chemonucleolysis over discectomy due to its minimally invasive nature, as well as reports of shorter hospital stay, early rehabilitation, and no back muscle trauma during the procedure. 44 However, it is important to note that chemonucleolysis can result in early disc degeneration compared to operative discectomy.…”