Disclosures: Anupam Sinha, DO: Nothing to disclose

Case Description: Patient presents to our clinic with complaints of insidious back pain. She is a daily runner. Denies any injury. Denies radicular pain. Pain is increased with lumbar movements, and also during sleep. Physical examination reveals normal lower extremity strength and neuromuscular examination. There is tenderness to palpation in the lower lumbar paraspinals. Pain is reproduced with lumbar flexion, extension, and rotation.

Setting: Orthopedic practice

Patient: 16-year-old female

Assessment/Results: X-rays of the lumbar spine show slight scoliotic curvature, without evidence for fracture. MRI of the lumbar spine shows marrow edema in the right L3 pedicle, corresponding to the concavity of the mild scoliosis, compatible with stress response. Patient was given a lumbar corset to wear and asked to stop running for 8 weeks. On follow-up she was referred to physical therapy for lumbar conditioning exercises. She was able to resume pain free running within 3 months.

Discussion: We present an unusual case of an L3 pedicle stress response in a young female runner with mild lumbar scoliosis. Due to the mechanics and high impact of her long-distance running, she developed a stress response at the area of increased strain in her lower lumbar spine. Treatment for this type of injury includes bracing, cessation of sports, and lumbar spine conditioning through physical therapy.

Conclusion: Clinicians should order advanced spinal imaging in young athletes with acute back pain to rule out stress injuries.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/idiopathic-scoliosis-with-unusual-pedicle-stress-fracture-a-case-report/