title: Spondylolysis of the second lumbar vertebra treated with segmental wiring and bone grafting.
abstract: Spondylolysis affects mostly the lower lumbar spine and rarely the upper lumbar spine. In a literature research, we found that the descriptions of spondylolysis of the upper lumbar spine had been reported mainly with the outcomes of conservative treatment using lumbosacral supports. However, an indication of surgical treatment has rarely been reported. Ravichandran et al reported 2 cases of spinal fusion, decompression or a combination of these procedures, but the procedures have not proved satisfactory in cases of upper lumbar spondylolysis. We found no reports of segmental wire fixation and bone grafting for upper lumbar spondylolysis. Herein, we report spondylolysis of the second lumbar vertebra in a 27-year-old man. He presented with pain and tenderness at the L2 spinous process, and swollen paravertebral muscles. The patient first became aware of lumbago at age 24 years. Much of his work involved heavy labor. He was diagnosed with spondylolysis of L2 and treated conservatively by a general orthopedist from age 25 to 27 years, but without improvement. We performed segmental wire fixation of the transverse and spinous processes of L2, followed by a bone graft. Six months after surgery, the lumbago had resolved and the patient was able to return to work. Three years after surgery, his pain is completely resolved. This is the first report in the English literature in which a successful indication for symptomatic spondylolysis in the upper lumbar spine is described.
authors.affiliation: Department of Orthopedic Surgery, Gifu University School of Medicine, 1-1 Yangido, Gifu 501-1194, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Hioki
authors.forename: Kazuichiro
authors.initials: K
authors.lastname: Ohnishi
authors.forename: Kei
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Hideo
authors.initials: H
authors.lastname: Hosoe
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shimizu
mesh_terms: D016025:Bone Transplantation / Q000295:instrumentation* / Q000379:methods; D001864:Bone Wires; D006801:Humans; D017116:Low Back Pain / Q000209:etiology* / Q000517:prevention & control*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D055009:Spondylosis / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult