Rationale in the management of 4-level lumbar spondylolyses with or without instability and/or spondylolisthesis.

Study Design: Case report.

Objective: To report the first case of 4-level lumbar spondylolysis in the literature.

Summary Of Background Data: Although there are quite a few reported cases of 2- or 3-level spondylolysis, none reported on 4-level spondylolysis. Management guidelines have not been suggested in literature.

Methods: A 48-year-old female presented with long-standing severe spinal instability, low back pain, and bilateral neurogenic claudication. Management of the patient with 4-level spondylolysis, varied clinical profile of each of the levels with respect to clinical symptoms and treatment based on the usefulness of pars block is described.

Results: Two levels were treated with intervertebral fusions, 1 level with pars repair, and conservative treatment of the last level pars lysis yielded in good clinicoradiological outcome in our patient.

Conclusion: Success of management of multiple lyses depends on the choice of appropriate treatment for each level separately. Pars block is a good invasive investigation to detect the symptomatic levels in a complex situation.