Consecutive double-level lumbar spondylolysis successfully treated with the double “smiley face” rod method

We report a case of double-level lumbar spondylolysis at L4 and L5 that was successfully treated with the double “smiley face” rod method. A healthy 29-year-old man who presented with a 6-year history of chronic low back pain was referred to us for surgical treatment. Plain radiographs and computed tomography of the lumbar spine revealed bilateral pars defects at L4 and L5 without slip or scoliosis. The patient underwent direct repair of the pars defects using the double smiley face rod method at L4 and L5. There were no intraoperative or postoperative complications, and the patient had improved clinically by 1 year after surgery. The low back pain was completely disappeared and visual analog scale was 0. He restarted tennis again as the recreational level. While several techniques for direct repair of lumbar spondylolysis have been described, this is the first report of the double smiley face rod method being used to repair the consecutive double-level lumbar spondylolysis.