Spondylolysis L3
This is a rather uncommon entity seen on x-rays. This was a female patient in her late 40’s, with a complaint of diffuse low back and buttock pain on both sides. She also stated that sometimes she had a strange sensation in both thighs in front, and even the right heel, sometimes.
The tricky thing about this problem is that the spondylolysis could be old and without symptoms. Or it could be new and account for her symptoms. But the disc herniation could explain her symptoms too. She also has a smaller disc herniation at L4-5. Much of medicine is about probabilities, so you have to have a hierarchical list of probable causes of pain, and then pursue further diagnostic tests and treatments, and see if the patient responds in a way that favors one diagnosis over another.
After the initial x-rays, we decided to do a lumbar MRI scan. If it was negative, then the 
was probably the cause of the pain, especially given that the patient stated she did a Pilates movement lying on her back, over a barrel, hyper-extending her low back- just the sort of act that is likely to aggravate a spondylolysis lesion. But the MRI showed another likely cause of her symptoms, so now we have two competing potential causes, and remain unsure of the cause of her pain. So we’ll proceed with treatment, and she if she responds in a way that favors one diagnosis over another.
It should be noted that a CT scan is the best way to evaluate spondylolysis, and she may eventually need that too, although it may be superfluous, which is why we didn’t order it immediately.
Another tricky component to this patient’s problem, is that the treatment for a disc herniation can be relatively contra-indicated for a spondylolysis lesion. As noted in this video, spondylolysis is actually a fracture in the weakest part of the vertebra, called the pars interarticularis.
If I can help you with your back or neck problem, please call 404-558-4015.
