Symptomatic Unilateral Spondylolysis Associated With Nonspondylolytic Lateral Clefts in Adults: Review of an Infrequently Reported Pathology

Vibhukrishnan Viswanathan,Sakthivel Rajan Rajaram Manoharan,Surabhi Subramanian

doi:10.7759/cureus.928

Vibhukrishnan Viswanathan, Sakthivel Rajan Rajaram Manoharan + Show 1 more

Open Access

https://doi.org/10.7759/cureus.928

Copy DOI

Abstract

Nonspondylolytic lateral clefts of the lumbar neural arch (laminolysis and pediculolysis) are rare pathologies that usually occur consequent to repetitive stress injuries in patients with unilateral spondylolysis. These lesions are different from the usual bilateral spondylolytic defects, and their management depends upon the chronicity and the type of bony defect. We hereby discuss the verdict of current literature on underlying pathomechanics and ideal management guidelines of these rare lesions.

Highlights

BackgroundLytic spondylolisthesis typically results from a bilateral defect in the pars interarticularis, which occurs following acute fractures or stress/fatigue failures [1]
In order to understand the actual phase of healing and plan the appropriate treatment, magnetic resonance imaging (MRI) is, a better modality [11]
Based on MRI appearance, the lateral nonspondylolytic clefts of the lumbar arch can be classified into four different groups: 1) acute healing pediculolysis; 2) chronic pediculolysis with fibrous nonunion; 3) acute healing laminolysis; and 4) chronic laminolysis with fibrous nonunion

Summary

Introduction

Lytic spondylolisthesis typically results from a bilateral defect in the pars interarticularis, which occurs following acute fractures or stress/fatigue failures [1]. Miyagi et al classified laminolytic defects into hemilaminar (sagittal fracture-line orientation) and interlaminar subtypes (coronal orientation) based on their morphological appearance [7] Both these defects (pediculolysis and laminolysis) occur following a similar mode of failure as in spondylolysis, i.e., recurrent extension loading of the posterior vertebral elements with superadded rotational stresses. Recurrent microtrauma following repetitive hyperextension and rotational stresses delivered across a relatively hyperlordotic, hypoplastic, or dysplastic lumbar spine lead to gradual failure of the neural arch [8] These lesions have been described in active laborers [9,10] or adolescent sportspersons who are prone to repeated, chronic injuries [6]. Certain reports have described [10] single level or multilevel insufficiency pedicle fractures in elderly patients in association with severe osteoporosis or renal osteodystrophy

Evaluation

Conclusions

Disclosures