Instructions
You are a medical student on placement in general practice. Your next patient is Duy Pham, 16, a fast bowler in the state under-17 cricket squad, with two months of low back pain when bowling; he is back with his mother, Lan, for his MRI result.
Explain the results and your management plan to the patient and his mother
- You do not need to take a further history or examine the patient.
- The examiner will speak for his mother.
- The examiner will ask you one question at the end.
From the visit three weeks ago
Right-arm bowler; bowls four days most weeks, about 20 overs over one weekend last month. Pain worse bowling and arching back, more on the left. No leg pain, numbness or weakness. Pain on arching back, worse standing on the left leg; tight hamstrings; leg neurology normal. X-rays: no slip.
MRI lumbar spine (report)
Acute bilateral L5 pars interarticularis stress fractures with bone marrow oedema: complete on the left, incomplete on the right. No slip. Discs and nerve roots normal at all levels; rest of the lumbar spine and sacrum normal.
MRI lumbar spine (report)
| Item | Value | Reference range |
|---|---|---|
| L5 pars interarticularis, left | Fracture line across the pars with surrounding bone marrow oedema | - |
| L5 pars interarticularis, right | Incomplete fracture line with bone marrow oedema | - |
| Alignment | Normal; no forward slip of L5 on S1 | - |
| Discs and nerve roots | Normal at all levels; no nerve compression | - |
| Rest of the lumbar spine and sacrum | Normal | - |
Clinical details: 16-year-old fast bowler, 2 months of low back pain with bowling. Conclusion: acute bilateral L5 pars interarticularis stress fractures (spondylolysis), complete on the left and incomplete on the right, with active bone oedema. No spondylolisthesis.