Two-Level Spontaneous Pedicle Fracture above a Degenerative Spondylolisthesis and Minimally Invasive Treatment

Symptomatic Unilateral Pediculolysis Associated with Contralateral Spondylolysis and Spondylolisthesis in Adults-Case Report and Review of Literature

BACKGROUND

The term "pediculolysis" encompasses rare, chronic pedicular changes characterized by pedicle hypertrophy, sclerosis, and pseudoarthrosis, which develop secondary to recurrent microfractures from repeated stress injuries. These stress injuries to pedicles can be insufficiency fractures, commonly reported in elderly patients with associated osteoporosis, or fatigue fractures, which occur in young adolescents involved in heavy sports. These pedicular lesions have been reported in association with defects in other components of the neural arch, including the pars interarticularis and lamina.

CASE DESCRIPTION

We have described a rare case of grade 1 spondylolisthesis with left-sided pediculolysis and contralateral pars lysis in a middle-age female patient without associated osteoporosis or comorbidities. She underwent L5-S1 transforaminal lumbar interbody fusion after initial conservative measures had failed. However, her symptoms persisted even after the surgery and necessitated revision surgery, including left L5 medial pediculectomy, neurolysis of the left L5 nerve root, and extension of instrumentation to L4 bilaterally and L4-L5 posterolateral fusion.

CONCLUSION

We have reported the present case to bring awareness to spine surgeons regarding the existence of this rare entity even in middle-age individuals. From our experience with the present patient, we believe that for patients with L5 pediculolysis and spondylolisthesis, the option of L5 medial pediculectomy and extension of instrumentation to L4 level should be considered.