Traumatic spondylolysis in a heptathlete: a case history and review

Objective: To summarize the literature on stress fractures amongst athletes and to present an unusual case of an L2 stress fracture in a heptathlete who was successfully treated initially with chiropractic care and then aggravated by it. Clinical Features: An elite heptathlete was diagnosed with bilateral pars interarticularis stress fractures of the L2 vertebrae. She initially presented for chiropractic treatment with unremitting low back pain. This followed previous successful treatment for back pain. After a series of unsuccessful treatments a second opinion (chiropractor) was sought. After a thorough history and examination, a series of radiographs were performed. Single photon emission computed tomography (SPECT) imaging confirmed the presence of bilateral spondylolysis at L2. Intervention and Outcome: The patient began a graduated return to function that was initially based in rest and avoidance of all extension and rotational movement of the lumbar spine. Management gradually returned the patient to general activity followed by more progressive and sport specific activity after the fracture had sufficient time to heal. Conclusions: This case highlights the importance of considering the type of pain, its location, the mechanism of injury, imaging studies and the result of the treatment in the short and medium term in establishing an accurate diagnosis of stress fracture of the pars interarticularis.