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

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 The repeated radiography and computed tomography demonstrated the pars defect had disappeared and been replaced by trabeculation, with no evidence of progressive segmental instability or vertebrae slip.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.