Chronic Back Pain from Four-Level Lumbar Spondylolysis with Associated Spondylolisthesis: Case Report and Review of the Literature

Summary There is an abundance of published literature discussing the treatment of single-level lumbar spondylolysis and spondylolisthesis. However, the treatment of patients with chronic back pain and multiple levels of combined lumbar spondylolysis and spondylolisthesis are not well-described in the existing literature. Introduction The purpose of this case report is to review the literature and describe the successful treatment of a patient who had chronic back pain and multiple levels of lumbar spondylolysis with associated spondylolisthesis. Methods A 32 year old male soldier had 4 level lumbar spondylolysis and L4-5 spondylolisthesis. He had chronic back pain that was refractory to conservative measures over a period of 3 years. He was treated surgically with single level lumbar fusion at the level of L4-5 spondylolisthesis. The other levels of lumbar spondylolysis were not stabilized. The patient demonstrated an excellent functional outcome at 2 years postop and was able to return to unrestricted military duty. Radiographs at 2-year follow-up showed solid L4-5 fusion with no evidence of spondylolisthesis at any other lumbar level. Conclusion Single-level lumbar fusion may be an appropriate treatment option for patients with chronic low back pain and multiple levels of spondylolysis. Functional outcome was excellent without evidence of instability at 2 year follow-up. Significance This case report highlights the effectiveness of single-level lumbar fusion in patients who have multiple levels of preexisting spondylolysis. Further study is recommended.