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Successful Bony Healing For An Adult Patient With Isthmic Spondylolysis At Terminal Stage After Conservative Treatment: A Case Report

Authors Ying J, Hou L, Teng H

Received 10 April 2019

Accepted for publication 10 October 2019

Published 5 December 2019 Volume 2019:12 Pages 3257—3261

DOI https://doi.org/10.2147/JPR.S211785

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 2

Editor who approved publication: Dr Katherine Hanlon


Jinwei Ying,1 Lisheng Hou,2 Honglin Teng1

1Department of Orthopedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 2Department of Orthopedic Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, People’s Republic of China

Correspondence: Lisheng Hou
Department of Orthopedic Surgery, The Sixth Medical Center of PLA General Hospital, Fucheng Road, Haidian District, Beijing, People’s Republic of China
Tel +86 10 68780323
Fax +86 10 68780323
Email houlishengngh@163.com
 
Honglin Teng
Department of Orthopedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Street, Ouhai, Wenzhou 325000, Zhejiang, People’s Republic of China
Tel +86 577 55979391
Fax +86 10 55979391
Email 907173102@qq.com

Purpose: Spondylolysis, a defect or fracture of the pars interarticularis due to mechanical stress, is a common cause of lower back pain (LBP) in children and adolescents. Although conservative treatment has been shown to be most effective for young patients at early or progressive stage, few studies have reported the outcomes of conservative treatment for adult spondylolysis at terminal stage. We present the possibility of bony healing in the isthmic defect at terminal stage after conservative treatment.
Patients and methods: A 50-year-old male patient complaining of moderate LBP was diagnosed as having L5 bilateral pars defect accompanied with related grade I spondylolisthesis though radiological evaluation. Magnetic resonance imaging revealed the sclerotic change in the defect of the isthmus, indicating spondylolysis at the terminal stage. This patient was treated with conservative management including lower back muscle functional exercises and medication when necessary.
Results: After five years of follow-up, the patient had a good recovery without reoccurrence. The repeated radiography and computed tomography demonstrated the pars defect had disappeared and been replaced by trabeculation, with no evidence of progressive segmental instability or vertebrae slip.
Conclusion: Symptomatic adult patients with isthmus spondylolysis at terminal stage might still have an opportunity to be effectively managed with rigorous conservative treatment for obtaining bony healing. However, the progression of listhesis or persistent debilitating pain should warrant consideration for surgical treatment.

Keywords: spondylolisthesis, isthmus, pars interarticularis, lower back pain, bony union

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