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Twenty-nine-Year Follow-up of Nonoperatively Treated Three-Level Lumbar Spondylolysis

A Case Report and Review of the Literature

Wu, Xiao-Dong, MD*,1; Wang, Xin-Wei, MD*,1; Chen, Hua-Jiang, MD1,a; Cao, Peng, MD*,1; Chen, Yu, MD1; Raley, Thomas John, MD2,b; Chen, Yuan-Yuan, MD1,c; Yuan, Wen, MD1,d

doi: 10.2106/JBJS.CC.O.00140
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Update This article was updated on May 25, 2016, because of a previous error. On page 4, in the address block, one of the e-mail addresses was incorrectly identified. The line had previously read “E-mail address for Y.-Y. Chen: yugangg@163.com.” The sentence now reads “E-mail address for Y. Chen: yugangg@163.com.”

Case: Multilevel spondylolysis, especially involving more than two levels, is rarely encountered in clinical practice. We present a case of three-level spondylolysis with two-level spondylolisthesis followed for twenty-nine years after nonoperative treatment. The patient was a forty-six-year-old man who presented with stabbing pain in the lower left portion of his back without radiating symptoms or neurological deficit. Lumbar radiographs showed bilateral pars defects at L3, L4, and L5 and grade-I spondylolisthesis at L4/L5 and L5/S1, but flexion and extension views showed no obvious translation. Review of medical records showed that the patient had already had three-level bilateral spondylolysis at L3, L4, and L5 almost thirty years ago. The patient had no history of lumbar surgery during the intervening years. Nonsteroidal anti-inflammatory drugs were initially prescribed. Physical therapy was prescribed for eight weeks, and the low back pain improved.

Conclusion: For patients with multilevel lumbar spondylolysis without neurological symptoms and with slippage of <25%, we recommend conservative treatment with regular follow-up.

1Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China

2VA Pain Management and Surgical Center, Arlington, Virginia

aE-mail address for H.-J. Chen: spine.chen@163.com

bE-mail address for T.J. Raley: thomasjraley@gmail.com

cE-mail address for Y. Chen: yugangg@163.com

dE-mail address for W. Yuan: yuanwenspine@163.com

*Xiao-Dong Wu, MD, Xin-Wei Wang, MD, and Peng Cao, MD, contributed equally to the writing of this article.

Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated
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