The question presents a 13-year-old gymnast with the acute onset of low back pain that is activity related. Her radiographs are normal, but a SPECT scan shows increased signal of the L5 pars, indicative of impending or acute stress reaction spondylolysis. The reference by Cohen & Stuecker demonstrated that bracing and avoiding strenuous activities prevented the formation of pars defects in patients with impending spondylolysis. Early diagnosis was made with MRI. Patients should wear a lumbosacral orthosis full time for 6 to 12 weeks.
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