The imaging and management of nonconsecutive pars interarticularis defects: A case report and review of literature

Abstract

Background context: Lumbar spondylolysis is a well-recognized condition occurring in adolescents because of repetitive overuse in sports. Multiple-level spondylolysis involving consecutive lower lumbar segments are rare. Several authors have reported failure of conservative treatment in the management of multiple-level pars fractures. Study design: A case report and review of previous literature is presented. Objective: The objectives of this case report were to present a rare case of pars fracture involving nonconsecutive segments and discuss image findings and treatment. Methods: The patents history, clinical examination, computed tomography (CT), magnetic resonance imaging (MRI) findings, and treatment are reported. We also discuss the pathogenesis, various treatment options, and review the literature. Results: We present the fourth case of bilateral pars fractures involving nonconsecutive lower lumbar spine segments of L3 and L5, in a 16-year-old young adolescent footballer who presented with 4-month history of constant low back pain. After 1 year of conservative management, the more acute fractures at L3 showed complete bony union, symptomatic pain relief, and return to full sporting activity. Conclusion: We report a rare case of bilateral pars fractures involving nonconsecutive segments. Multiplane reconstruction of CT images and MRI are very useful in planning treatment and follow-up. Conservative management may be used to treat multilevel nonconsecutive pars fractures. © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.