Unilateral Pedicle Fracture Accompanying Spondylolisthesis and Contralateral Spondylolysis: A Case Report

Study design Case report Objective: To report a rare case with unilateral pedicle stress fracture accompanying spondylolytic spondylolisthesis. Summary: of Background Data Unilateral pedicle stress fracture accompanying spondylolytic spondylolisthesis is rare. Most are association with major trauma, previous spine surgery, osteopetrosis or stress-related activities. Methods: We report a patient with spontaneous pedicle fracture associated with contralateral spondylolysis and spondylolisthesis at the L5 level, complaining severe back pain, radicular lower limb pain and intermittent claudication. The pathophysiological mechanism is discussed, and a review of relevant literature is included. Results: This patient was successfully treated by decompression laminectomy with transforaminal lumbar interbody fusion (TLIF) and pedicle screw fixation. To our knowledge, cases like this have rarely been reported in the literature. Conclusions: Unilateral pedicle stress fracture in patients with spondylolytic spondylolisthesis is rare. It may be related to redistribution of forces in an unstable neural arch resulting from defect in the contralateral pars interarticularis. Our experience suggests that limited decompression and instrumented fusion surgery led to a successful outcome.