Multilevel lumbar spondylolysis: case report and literature review

Introduction Diagnosis and treatment of vertebrogenic pain syndrome caused by multilevel lumbar spondylolysis is crucial for patients of different age groups. Objective To report a clinical case of diagnosis and treatment of a two-level lumbar spondylolysis in a 16-year-old male patient, and review the relevant literature. Material and methods We had an experience of treatment and follow-up of a 16-year-old athlete who presented with low back pain and was diagnosed with spondylolysis of the pars interarticularis at the L3 and L5 levels. Diagnostic workup included patient history, physical examination, diagnostic imaging (plain radiograph, computed tomography). Scientific publications from modern medical databases were used for literature review. A total of 32 relevant articles brought out between 1975 and 2019 were reviewed. Results The 16-year-old athlete was diagnosed with multilevel spondylolysis of lumbar spine based on patient history, physical examination data and diagnostic imaging of lumbar spine. No pathognomonic clinical findings were revealed. The diagnosis was confirmed with computed tomography. Conservative treatment was initiated for the patient and a long-term-follow-up was available. Literature review included epidemiologic data characterizing multilevel lumbar spondylolysis: the indicence, patients' gender and age. Major etiological factors, common localization of the pathology, the incidence of spondylolysis and spondylolisthesis, treatment strategy including surgical procedures are described. Discussion There is a small number of scientific publications describing different aspects of multilevel spondylolysis of the lumbar spine in the current medical literature. The diagnosis is often delayed for the reason. The natural history of pain in adolescent athletes sustaining the load placed on them in both training and competition can be helpful for timely diagnosis. Conclusion The implications of this clinical case report can be practical for accentuation of multilevel spondylolysis of the lumbar spine among Russian specialists, contribute to medical knowledge and extend to both early diagnosis and efficient management.