A case of a baseball player with bilateral progressive-stage spondylolysis of the fourth lumbar vertebrae who underwent minimally invasive screw fixation and achieved early return to competition after operation

Abstract

The patient was a 13 years and 11 months old male baseball player. He experienced low back pain 36 days before his first visit but continued to play baseball. The back pain worsened 18 days before his first visit; therefore, he was referred to our hospital with a diagnosis of lumbar spondylolysis. We suggested conservative treatment, but he hoped to return to playing baseball as soon as possible. The lesion was progressive bilaterally, which is one of the factors that inhibits bone union during conservative treatment. Therefore, we decided to perform surgery. One month after the first visit, he underwent pars defect repair with minimally invasive screw fixation and wore a semi-rigid brace postoperatively. Two months after surgery, bone union was achieved, and he returned to playing baseball. In general, lumbar spondylolysis is first treated conservatively and then surgery is recommended when pseudoarthrosis develops. However, we performed surgery based on previous reports, considering the patient’s desire to return to sports activities at an early stage and the union rate of conservative treatment. Minimally invasive screw fixation of lumbar spondylolysis through a small skin incision is a useful treatment that ensures early return to competition and bone union.