Poster 57: Anomolous ossicle of the lumbar zygapophyseal joint as a source of back pain in a gymnast: a case report

Abstract

Setting: University-based physician’s office. Patient: A 13-year-old gymnast who was in good spinal health until she was a restrained front-seat passenger in an automobile collision. Case Description: She had immediate onset of severe low back pain (LBP) that became chronic and limited her ability to participate in athletic activities. She was seen for a consultation due to the refractory nature of her condition. Assessment/Results: Physical examination was significant for pain with extension to the right and the neurologic examination was nonfocal. We obtained radiographs that included standing anteroposterior (AP), lateral, and flexion and extension views of the spine. AP views were significant for a bony defect of the right L3 inferior zygapophyseal joint. We obtained a new magnetic resonance imaging, which confirmed the bony defect of the right L3 inferior zygapophyseal joint on coronal views. A diagnostic fluoroscopic injection of 0.5mL of 2% lidocaine (Xylocaine) was performed. During the anesthetic phase, she had 100% pain relief and was able to perform spinal extension without return of her symptoms. The patient later underwent a resection of the ossicle and is now pain free. Discussion: LBP has been increasingly recognized as a problem of adolescents as well as adults. Back pain can pose a diagnostic dilemma to the physician trying to determine the specific pain generator. In the event of acute traumatic events or chronic LBP, obtaining radiographic information can be useful in such cases as spondylolysis, scoliosis, and acute fractures. Conclusion: This case underscores the importance of correlating patient history, physical exam, and pain drawings to the appropriate imaging studies. When doubt of diagnosis exists, a fluoroscopically guided injection of anesthetic to the suspected source of the pain may be required to corroborate the evidence.