Abstract
CASE HISTORY: A 20-year-old collegiate multi-event track athlete with chronic low back pain presented with 3 weeks of worsening lumbar pain and bilateral paresthesias into the gluteal region. Symptoms worsened with heavy lifting and trunk flexion/rotation. He denied trauma and bowel/bladder dysfunction. An NSAID and muscle relaxant were ineffective and he stopped sport. Imaging led to L5 pars repair. On postoperative day 4 he returned with headache, photophobia, neck pain, and fever. PHYSICAL EXAM: Lumbar tenderness at L4/5 midline and paraspinals; pain with rotation. No pain with flexion/extension/side-bending. Straight-leg raise negative. Normal gait; lower-extremity strength 5/5, sensation intact, reflexes 2+. DIFFERENTIAL DIAGNOSES: Lumbar strain; pars stress fracture/spondylolysis; lumbar disc pathology; postoperative CSF leak/postdural puncture headache; meningitis. TESTS & RESULTS: MRI: anterolisthesis of L5 on S1. CT lumbar spine: bilateral L5 spondylolysis with mild L5–S1 spondylolisthesis. Readmission CT showed a postoperative fluid collection concerning for CSF leak. CBC/CSF: leukocytosis; CSF pathogen panel negative; blood cultures negative. CT head: no acute intracranial abnormality. FINAL DIAGNOSIS: Bilateral L5 spondylolysis with mild L5–S1 spondylolisthesis with postoperative CSF leak and concern for meningitis. DISCUSSION: Pars defects are overuse stress injuries (often L5) associated with repetitive extension/rotation and can cause mechanical low back pain with gluteal radiation. MRI may detect early stress; CT confirms the defect and slip. Management begins with activity modification and core/hip stabilization; surgery is considered for persistent pain, bilateral defects, or symptomatic slip. OUTCOME OF THE CASE: Underwent L5 pars repair with hook-rod construct. On readmission he was treated empirically for suspected meningitis, and a lumbar drain was placed for 5 days due to concern for CSF leak. He was discharged with a PICC for 14 days of cefepime and vancomycin. Recovery was otherwise uneventful; he resumed light activity avoiding running and heavy lifting. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Return is gradual and guided by healing and symptoms; typical timeline is 9–12 months. He is on track for full return at ~9 months.
Recommended Citation
Patel, Maitri; Roby, Emily; Neuberger, David; and Stamatis, Andreas
(2026)
"Chronic Low Back Pain – Track,"
International Journal of Exercise Science: Conference Proceedings: Vol. 15:
Iss.
8, Article 28.
Available at:
https://digitalcommons.wku.edu/ijesab/vol15/iss8/28