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A delayed diagnosis of high-grade spondylolisthesis
Ana Maria G Kolenko1, Jennifer M Bauer
1Ana Maria G. Kolenko practices in pediatric orthopedic spine surgery at Seattle (Wash.) Children's Hospital. Jennifer M. Bauer is a pediatric orthopedic spine surgeon at Seattle Children's Hospital and an assistant professor of orthopedic surgery at the University of Washington in Seattle. Dr. Bauer discloses that she is a consultant for Synthes DePuy, the orthopedic company of Johnson & Johnson. The authors have disclosed no other potential conflicts of interest, financial or otherwise.
Spondylolysis, a pars defect, is common in children with back pain. Delayed diagnosis, like in an 8-year-old with heel pain, can lead to significant quality of life reduction.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Sports Medicine
Background:
- Spondylolysis, a pars defect, affects nearly half of children experiencing back pain.
- Diagnosis of spondylolysis with spondylolisthesis is frequently delayed or missed due to referred pain and atypical symptoms.
Observation:
- An 8-year-old girl presented with 15 months of right heel pain.
- Initial treatment focused on presumed Sever disease by her primary care provider.
- Referred to orthopedics, she was diagnosed with high-grade spondylolisthesis and L5 nerve root compression.
Findings:
- Spondylolysis, while infrequent in young patients, can present with non-specific symptoms like heel pain.
- High-grade spondylolisthesis can cause significant neurological compromise, including nerve root compression.
Implications:
- Early recognition of spondylolysis in pediatric patients is crucial for timely intervention.
- Atypical presentations necessitate a broad differential diagnosis in pediatric musculoskeletal pain.
- Prompt diagnosis and management of spondylolisthesis can prevent long-term morbidity and improve patient outcomes.
