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Spondylolysis of the Fourth Lumbar Vertebra

- Discussion:
    - disruption of the pars interarticularis occurs less frequently at L4;
    - symptomatic spondylolysis at this level is reportedly more common in young adults than in children or adolescents;
    - in 25% of affected patients, it is associated with either partial or complete sacralization of L5;
    - it may be unilateral or bilateral;
    - most common in males sustaining trauma;
    - intensity of pain in back & of functional impairment are greater w/spondylolysis is at L4 as compared to L5;
          - incidence of  neurological signs compared to L5 spondylolisis;
    - progression to Grade-I Spondylolisthesis has been reported in adults, but severe slipping is unusual;
    - neurological signs and symptoms are more frequent, however, when there is progression to Spondylolisthesis