Differential Diagnosis for Bilateral Pars Interarticularis Defect of L5 with Associated Mild Spondylolisthesis

• Single Most Likely Diagnosis
  • Spondylolysis with spondylolisthesis: This condition is characterized by a defect in the pars interarticularis, which can lead to slippage of the vertebra (spondylolisthesis). The presence of bilateral pars defects and grade 1 spondylolisthesis supports this diagnosis, as it is a common cause of low back pain in adolescents and young adults.
• Other Likely Diagnoses
  • Degenerative disc disease: This condition can contribute to or exacerbate spondylolisthesis, especially in older adults. The mild spondylolisthesis could be a result of disc degeneration.
  • Spondylolisthesis due to other causes (e.g., degenerative, traumatic, or pathological): While less common, other factors could contribute to the development of spondylolisthesis, including trauma, infection, or tumors.
• Do Not Miss Diagnoses
  • Infection (e.g., osteomyelitis, discitis): Infections of the spine can cause destruction of the pars interarticularis or the disc, leading to spondylolisthesis. Although less likely, missing an infection could have severe consequences.
  • Tumor (e.g., osteoid osteoma, osteoblastoma): Tumors can weaken the pars interarticularis, leading to a defect and potential spondylolisthesis. Early detection is crucial for effective treatment.
  • Trauma: A traumatic event could cause or exacerbate a pars defect and spondylolisthesis. It's essential to consider trauma, especially if the onset of symptoms was sudden.
• Rare Diagnoses
  • Congenital spondylolisthesis: This is a rare condition where the spondylolisthesis is present at birth, often due to a congenital defect in the formation of the spine.
  • Neuromuscular spondylolisthesis: Certain neuromuscular conditions can lead to spondylolisthesis due to muscle imbalance or weakness. This is less common and typically associated with specific underlying conditions.