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Background <p>Chronic orchialgia is usually investigated within a urological framework. A spinal origin is uncommon and is typically associated with low back pain or radicular symptoms. Isolated orchialgia caused by an occult lumbar pars defect has not yet been reported in literature.</p> Case Description <p>A 52-year-old man presented with persistent right-sided orchialgia despite extensive urological evaluation and conservative treatment. He had no low back pain, radicular symptoms, or neurological deficits. Plain radiographs suggested a right L5 pars defect. Lumbar MRI demonstrated a unilateral L5 pars defect with T1 hypointensity and T2 hyperintensity, raising suspicion for an active lesion. SPECT-CT confirmed focal increased osteoblastic activity, indicating a metabolically active non-healed pars defect. In the absence of any alternative identifiable cause, the pars lesion was considered the likely pain generator. The patient underwent minimally invasive L5–S1 transforaminal lumbar interbody fusion, resulting in complete resolution of orchialgia, which was maintained at one-year follow-up.</p> Conclusion <p>Occult L5 pars defects can rarely present solely as chronic orchialgia. A high index of clinical suspicion is crucial in patients with unexplained testicular pain and inconclusive urological evaluation. Functional imaging with SPECT-CT may help distinguish symptomatic pars defects from incidental lesions and guide definitive treatment.</p>

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Isolated Orchialgia as the Sole Manifestation of an Occult L5 Pars Defect: A Case Report

  • 期刊论文

  • 发表日期：

    2026年7月30日

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  • Arvind Gopalrao Kulkarni,
  • Priyambada Kumar,
  • Bala Ganeshan Thangaraj Pillai

摘要

Background

Chronic orchialgia is usually investigated within a urological framework. A spinal origin is uncommon and is typically associated with low back pain or radicular symptoms. Isolated orchialgia caused by an occult lumbar pars defect has not yet been reported in literature.

Case Description

A 52-year-old man presented with persistent right-sided orchialgia despite extensive urological evaluation and conservative treatment. He had no low back pain, radicular symptoms, or neurological deficits. Plain radiographs suggested a right L5 pars defect. Lumbar MRI demonstrated a unilateral L5 pars defect with T1 hypointensity and T2 hyperintensity, raising suspicion for an active lesion. SPECT-CT confirmed focal increased osteoblastic activity, indicating a metabolically active non-healed pars defect. In the absence of any alternative identifiable cause, the pars lesion was considered the likely pain generator. The patient underwent minimally invasive L5–S1 transforaminal lumbar interbody fusion, resulting in complete resolution of orchialgia, which was maintained at one-year follow-up.

Conclusion

Occult L5 pars defects can rarely present solely as chronic orchialgia. A high index of clinical suspicion is crucial in patients with unexplained testicular pain and inconclusive urological evaluation. Functional imaging with SPECT-CT may help distinguish symptomatic pars defects from incidental lesions and guide definitive treatment.