4 Sport Athlete Patient (BMI 21) with Known Spondylolysis

Here’s a Case to Think About: 4 Sport Athlete Patient (BMI 21) with Known Spondylolysis

Here is a patient (BMI 21) who was a 4 sport athlete in high school. She had known spondylolysis at L2-3 and L5-S1. She powered through these injuries in her teens to compete at a high level. Now in her 40s, she has been troubled with back pain.

Although she remained active the back pain became progressively worse limiting her typical high activity level. She also developed right sided thigh pain. On exam, her back pain is at the lower lumbosacral area and leg pain/numbness is located in the anterior right thigh. She has attempted to manage this conservatively without success.

Imaging demonstrates spondylolytic spondylolisthesis with development of segmental kyphosis at L5-S1 and without kyphosis at L2-3. She has asymmetrical disc space collapse at L2-3 with development of a small lumbar coronal curve.

How would you manage this case?

1. Anterior / Posterior VS. all Posterior VS. Standalone?
2. Fusion levels?
3. Osteotomies?