A 14-year-old elite gymnast has low back ache that worsens with lumbar extension and improves with rest. Oblique radiographs show a lucency across the isthmus of the pars interarticularis at L5 without significant vertebral slip. After confirming an acute lesion, the preferred initial management is:

• A Epidural corticosteroid injection followed by gradual return to sport
• B Continue training with core strengthening exercises only
• C Posterior lumbar interbody fusion at L5-S1
• D Cessation of gymnastics with a thoracolumbosacral brace for 6 to 12 weeks ✓

Explanation

Acute spondylolysis in a young athlete is managed by stopping the provocative hyperextension activity and bracing in a lumbosacral orthosis for about 6 to 12 weeks, which allows healing of the pars defect in many cases, followed by graded rehabilitation. The oblique view shows the Scottie dog with a collar around its neck, the classic appearance of the pars defect. Fusion is reserved for persistent symptomatic high-grade slips, and injections do not address the mechanical cause in a growing spine.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.