Non-Isthmic Spondylolysis Imaging Features: A Case Report

The leading cause of low back pain in our country like India in children and in adolescent has been found to be lumbar spondylolysis. This affects approximately 6-8% of adults in the general population which includes a large number of asymptomatic cases. The main cause in this disease is found to be that of fatigue features which are found in 10% of young adults during heavy labor work, sports, and athletic activities.

A 25-year-old, left hand dominant, cricket player was referred to Dr. DY Patil Hospital and Research Centre, Pimpri, Pune with complaint of low back pain while playing cricket with no neurological symptoms. His symptoms started 6 months back to this visit and have worsened despite conservative treatment with medications and rehabilitation. No obvious line was seen on the X-rays, but a right non-isthmic spondylolysis was noted at L5 on computed tomography scan. Based on our imaging findings and clinical examination, we made a diagnosis of non-isthmic spondylolysis. As the patient desired an early return to activity, we did not aim for bone union and provided pain relieving treatment which included temporary wearing of soft brace. As a result his pain improved.

In our case, the fracture type is more coronally oriented compared with a fracture line in typical spondylolysis. Furthermore, lifting weights transmit a force from the upper limb to lower limbs, it is likely that high loading causes this type of fracture. From a view of biomechanics, reducing extension loading should be an effective means in the treatment of this type of fracture.