610 - Recurrent lumbar pedicle stress fracture in a high-performance javelin athlete

A 21-year-old collegiate javelin thrower presented with six weeks of low back pain after intensive training. MRI revealed a left L5 pedicle/pars fracture without spondylolisthesis. His primary goal was a timely return to competition, with only eight weeks before the track season began. Conservative care with NSAIDs, rest, and physical therapy provided only temporary relief. His history was notable for bilateral L4 pedicle stress fractures five years earlier, successfully managed nonoperatively over months. Given the recurrence of pedicle fractures, he underwent a structured program of rest, rehabilitation via the Back Doctor App, and daily teriparatide injections. He returned to competition within 10 weeks, achieved personal best throws, and remained asymptomatic at six months.


Discussions:

Lumbar pedicle stress fractures, typically between L2–L5, result from repetitive rotational loading and are often missed on plain radiographs. MRI is the preferred diagnostic tool, clearly showing fracture lines and marrow edema while avoiding radiation exposure. Conservative treatment remains the mainstay, as the vascular supply to the pedicle favors bony union. Optimizing bone health with vitamin D, calcium, and teriparatide can further enhance healing. Rehabilitation should begin only once the patient is pain-free and able to maintain a neutral spine. The Back Doctor App provided structured, progressive lumbar stabilization, emphasizing advancement without pain or loss of alignment. In this case, combining a 3-month course of teriparatide with progressive rehabilitation enabled full recovery and high-level athletic performance, with return to competition in 10 weeks.


Conclusions:

Acute lumbar stress fractures are common in athletes, but recurrent pedicle fractures in javelin throwers are rare, with limited literature available. This case demonstrates successful conservative management with teriparatide and structured rehabilitation, enabling a timely return to competition while preserving spinal integrity and performance.