Low back pain with fracture of the pedicle and contralateral spondylolysis. A technique of surgical management

Abstract

We present a 26-year-old athlete with severe low back pain associated with a fracture of a lumbar pedicle and contralateral spondylolysis. The difficulties of diagnosis are discussed together with the subject of segmental pain referral. A technique of operative management is described involving instrumentation of the symptomatic level alone.

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

“…This is the reason while we proposed a conservative treatment. In most published cases, patients have undergone surgery either immediately or after an immobilization failure [10]. Despite the case of a spontaneous healing of the pedicle fracture without immobilization in a young gymnast female reported by Guillodo et al [5], we stress the importance of an effective lumbosacral junction immobilization, by means of a modified brace incorporating one thigh, to avoid L5 pedicle non union.…”

“…Unilateral spondylolysis associated with sclerosis and hypertrophy of the contralateral side of the neural arch is well described in the literature [1][2][3][4][5][6][7][8]10]. Pedicle fractures also occurred following contralateral isthmic spondylolysis, secondary to a weakening of the neural arch with resulting increased stress across the contralateral pedicle [1,2,4].…”

“…Pedicle fractures also occurred following contralateral isthmic spondylolysis, secondary to a weakening of the neural arch with resulting increased stress across the contralateral pedicle [1,2,4]. Unilateral spondylolysis associated with pedicular fracture has been described in competitive sport patients [2,5,10]. To explain pedicular fracture, authors usually insist on the asymmetric character of sports activities, requiring rotary movements.…”

“…Stress fracture of the vertebral pedicle in the lumbar spine associated with contralateral spondylolysis are already described in the literature [1][2][3][4][5][6][7][8]10], especially in competitive sport patients. This lesion has not been described previously during childhood.…”

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

“…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.…”