Lumbosacral Parameters and Intervertebral Disc Changes in Adult Patients with Pars Defects

Abstract

Introduction Pars defect refers to fracture in the pars inter articularis and is believed to be one of the leading cause of back pain. Pars defects usually acquired and caused by microtrauma. Spondylolysis is seen in 4–6% of population. 82% occur at L5/S1 and 11% occurs L4/5 (11%). Materials and Methods Between March 2013 and April 2014, we collected particulars of all patients presenting with low back pain with pars defects on standing erect lumbosacral spine X-rays. Patients were excluded if they had (1) Deformity, (2) Non availability of MRI. 57 patients were included. Their X-rays and MRI were studied by two orthopedic surgeons measuring: Lumbar lordosis and Sacral slope on Plain Xrays; Lumbar slip according to meyereding grading; Intervertebral disc status on MRI: (1) Disc degeneration according to Pfirmann's grading, (2) Degree of disc prolapsed. Results 57 subjects had their data reviewed: 30 males, 27 females; ages ranged between 15 and 65 years (mean age = 40 years). Data was collected and cleaned using Microsoft Excel. Then analysis done using SPSS ver.17.characteristics of the sample population were displayed in frequency tables while testing for correlations as wellas student t-testwere taken as significant for P values < 0.05. There's a significant difference between males and female ages (p-value 0.01); males were younger with a mean age of 37 years versus 45 years. Sacral Slope: Ranged between 17 – 64 degrees (Mean = 38 degrees). Lumbar Lordosis: ranged between 15 – 77 degrees (Mean = 52 degrees). Slip degree according to myerdings grading: Grade 0 = 38%, Grade 1 = 58%, and Grade 3 = 4%. On MRI disc changes according to Pfirmann's grading was grade 1 26%, grade 2 5%, grade 3 24%, grade 4 32%, grade 5 11%. And finally the disc prolapse severity wasas under: (1) No bulge 32%, (2) Bulge 29%, (3) Extrusion 34%, (4) Sequestration 4%. Statistically significant correlation found between: (1) Age and degenerative disc changes; cor. coefficient 0.43 and p value 0.001; (2) Age and prolapsed disc; cor. coefficent 0.39 and p value 0.003; (3) Degenerative disc changes and prolapse; cor. coefficient 0.83 and p value < 0.001; (4) Between sacral slope and lumbar lordosis; cor. coefficient 0.72 and p value < 0.001. Conclusions There is increased prevalence of disc degeneration in patients with pars defect. There is direct correlation between age and disc degeneration plus degree of disc prolapse. Severity of degeneration is directly related to degree of disc prolapse. The lumbar lordosis and sacral slope were not found be statistically related to degree of spondylolisthesis. The disc is not protected in patients with defect.