A Case of Nonconsecutive Multiple-level Lumbar Spondylolysis Successfully Treated with Single-level Repair of the Pars Interarticularis

Lumbar spondylolysis is commonly recognized at a single-level of the lumbar spine and frequently affects the L5 pars interarticularis unilaterally or bilaterally. Some reports have described multiple-level spondylolysis, most cases of which occur at consecutive lumbar segments. We herein present a rare case of lumbar spondylolysis involving nonconsecutive multiple-level segments; only eight such cases have been reported previously. A 38-year-old man presented with a 10-month history of chronic severe low back pain. Lumbar flexion–extension radiographs and computed tomography revealed spondylolysis at the level of L3 and L5, whereas no spondylolisthesis was present and the intervertebral disc spaces were maintained at all levels. Because 6 months of conservative management failed and repeated diagnostic blocks confirmed that the fracture of the L3 pars interarticularis was generating pain, repair of the bilateral L3 pars interarticularis with the smiley face rod method was performed. At the last follow-up 1 year after surgery, the patient had resumed normal life as a laborer and reported no back pain.