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Abstract
There is a broad range of lumbar pedicular and neural arch anomalies, with spina bifida occulta and spondylolysis being especially common. It is very rare for a pedicular cleft to be associated with contralateral spondylolysis in the same vertebral segment. We observed L4 spondylolisthesis, clefting of the left L4 hypertrophied pedicle associated with contralateral spondylolysis, and spinal stenosis on a radiographic study of the lumbar spine. Operative treatment was performed, with posterior decompression, partial removal of the hypertrophied pedicle, posterior lumbar interbody fusion using a cage, and posterior instrumentation. The patient’s neurologic symptoms resolved after operative treatment. Fusion of the left pedicle cleft was observed on 6-month follow-up CT. We report one case of pedicular cleft fusion using pedicle screw fixation and present a review of the relevant literature.
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REFERENCES
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 | Fig. 1.Plain radiographs show that olisthesis of 4th lumbar vertebra, hypertrophy of the left 4th lumbar pedicle and contralateral spondylolysis. |
 | Fig. 2.Computed tomographic findings of pedicular cleft. (A) 3D reconstruction CT image shows the cleft traverse the whole thickness of the left pedicle. (B) Axial CT image shows radiolucent gap in left pedicle with hypertrophic and sclerotic change and the lytic defect in right pars interarticularis. |
 | Fig. 3.MR findings of pedicular cleft. (A) Sagittal, coronal MR images show the cleft and hypertrophy of the left 4th lumbar pedicle. (B) Axial images show compression of 4th lumbar nerve root on left foramen by disc bulging and central, lateral recess stenosis by hypertrophied facet joint and disc degeneration. |
 | Fig. 4.(A) Whole body bone scan shows no uptake on 4th lumbar vertebra, (B) Bone SPECT (single photon emission computed tomography) images show tracer uptake on left 4th lumbar pedicle. |
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