Rationale in the Management of 4-Level Lumbar Spondylolyses With or Without Instability and/or Spondylolisthesis

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Study Design.

Case report.


To report the first case of 4-level lumbar spondylolysis in the literature.

Summary of Background Data.

Although there are quite a few reported cases of 2- or 3-level spondylolysis, none reported on 4-level spondylolysis. Management guidelines have not been suggested in literature.


A 48-year-old female presented with long-standing severe spinal instability, low back pain, and bilateral neurogenic claudication. Management of the patient with 4-level spondylolysis, varied clinical profile of each of the levels with respect to clinical symptoms and treatment based on the usefulness of pars block is described.


Two levels were treated with intervertebral fusions, 1 level with pars repair, and conservative treatment of the last level pars lysis yielded in good clinicoradiological outcome in our patient.


Success of management of multiple lyses depends on the choice of appropriate treatment for each level separately. Pars block is a good invasive investigation to detect the symptomatic levels in a complex situation.


Level of Evidence: N/A

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