Bilateral three-level lumbar spondylolysis repaired by hook-screw technique

Abstract

We report a case of bilateral three-level lumbar spondylolysis that was directly repaired by use of hook-screw technique. The patient complained of low back pain for 2 years that progressively worsened and was exacerbated with standing and walking. He also mentioned bilateral sciatalgia. The neurological examination was normal. Interestingly, we found bilateral lumbar spondylolysis in L3, L4, and L5 levels in imaging studies. After proving that spondylolysis was the source of the low back pain by local anesthetic agent injection, we used a direct technique for correction of spondylolysis by use of a hook-screw device plus decortications of lysis area and iliac crest autograft. We assessed the patient after surgery to evaluate pain recovery and fusion rate. The results were favorable and proved the efficacy of the hook-screw technique for treatment of symptomatic multilevel lumbar spondylolysis.

Keywords: hook-screw; low back pain; spondylolysis.

Figure 1

Preoperative plain X-ray showing three-level bilateral spondylolysis: right oblique (A), lateral (B), flexion (C), and extension (D) views.

Figure 2

Preoperative T2-weighted sagittal magnetic resonance imaging showing no sign of slip or disc degeneration.

Figure 3

Postoperative plain X-ray about 2 years after surgery showing anteroposterior (A), lateral (B), flexion (C), and extension (D) views, and computed tomography scan (E).