Bilateral Spondylolysis Research Articles

Bony Healing in a Patient with Bilateral L5 Spondylolysis

Bony Healing in a Patient with Bilateral L5 Spondylolysis

Spondylolysis at C6 Level and Associated Laminar Fracture of C5

We describe a 42-year-old woman with bilateral spondylolysis of the sixth cervical vertebra, unusual in that it was associated with a traumatic laminar fracture of C5. Cervical spondylolysis is a relatively rare condition associated with dysplastic changes of posterior elements at the same or adjacent levels. The lesion must be differentiated from traumatic articular pillar fractures in patients who have had cervical spine trauma. A combined multistudy approach is necessary to reach a definitive diagnosis and to decrease the potential for misdiagnosis and inappropriate therapy in most cases.

A Comparative Roentgenographic Analysis of the Lumbar Spine in Male Army Recruits with and without Lower Back Pain

AIM: To determine whether there is an association between lumbar spine radiographic findings and reported current and/or past lower back pain (LBP). MATERIALS AND METHODS: Four hundred and sixty-four age-matched (mean age 18 years±2 months) consecutive male army recruits were examined. Half of them had a history of episodes of LBP. An orthopaedic evaluation (including radiographs of the lumbar spine) is part of the routine medical examination for all military recruits. Two senior orthopaedic surgeons and one radiologist who performed the morphological measurements assessed the radiographs. RESULTS: We found an increased frequency of right-sided scoliosis, lumbar lordosis, sacral lumbarization, wedge vertebra, bilateral spondylolysis of L5 and/or a sagittal diameter of less than 12 mm among the recruits with LBP. No such association was found with spina bifida, left-sided scoliosis, hemi-lumbarization, sacralization and hemi-sacralization, Schmorl's nodules or mild degenerative changes. CONCLUSION: Given that radiographic screening shows that LBP is more common in those with spinal deformity it may be a reasonable means of predicting which individuals are more likely to develop LBP.

The effect of bone graft extenders to enhance the performance of iliac crest bone grafts in instrumented lumbar spine fusion.

Allograft bone extenders are commonly used in spinal surgery to increase the available graft volume, thereby promoting and achieving a solid fusion mass. We report a single surgeon's use and early results of autologous bone graft and allograft demineralized bone matrix in 65 patients undergoing lumbar spinal fusion. Of the patients included in this study, 59 (91%) patients underwent surgical intervention for lumbar spinal stenosis, three (5%) patients had lumbar spondylolisthesis, two (3%) patients had stenosis, and one (1%) patient had bilateral spondylolysis. Forty-three (64%) women and 22 (36%) men were included in the study. The average patient age was 56 years (20-85 years, SD= +/- 16). Independent radiographic evaluation was performed. Each subsequent radiographic follow-up revealed increased improvement in average Lenke score and was statistically significant between the early (1 month) and recent (12 month) follow-ups. There were statistically significant changes in Lenke score between 1 month and 3 months follow-up (P<.01), between 3 months and 6 months follow-up (P<.001), and between 6 months and 12 months follow-up (P<.01). The gradual and constant increment of improvement in radiographic measurements in this preliminary series may indicate a positive effect of the use of bone graft extenders that may decrease the required amount of autologous bone graft. Bone graft extenders also may minimize the risks and complications associated with the harvesting procedure.

SCOLIOSIS IN A TRACK AND SOCCER PLAYER

HISTORY 14 y/o female who plays soccer and track/cross country presented with low back pain. She has a prior diagnosis of twenty degree levo scoliosis which was discovered one year ago when she had a prior episode of low back pain. This pain resolved after physical therapy and a course of NSAIDs. Current symptoms included right sided back pain after flexion, extension, and rotation of the spine while stretching. She denied any weakness, numbness, tingling of the lower extremities, but was experiencing increasing amounts of pain with running and with sitting and lying down. On occasion, she had experienced two to three/seconds of shooting pain down the lateral aspect of the right thigh. PHYSICAL EXAMINATION Right sided low back pain with lumbar extension and right single leg extension - there was less right sided low back pain with left single leg extension Full range of motion to flexion with right sided paraspinal fullness and tenderness L3-L5 Low back pain on the right with SLR of the right and left lower extremities to 70 degrees Sensation, propioception, motor strength, and reflexes were all normal. DIFFERENTIAL DIAGNOSIS Idiopathic Scoliosis. Paraspinal Spasm. Lumbar Strain. Spondylothiasis/Spondylolysis. TEST AND RESULTS Lateral/oblique/PA xrays of the spine- 22* scoliosis. Bilateral spondylolysis of L5/S1. CAT SCAN of the Lumbosacral Area. Bilateral L5 Spondylolysis. Levoscoliosis with Apex Curve at L3. No Level of Central Spinal Canal or Foraminal Stenosis. FINAL WORKING DIAGNOSIS L5/S1 Spondylolysis with 22* Scoliotic Curve. TREATMENT AND OUTCOMES Immobilition with custom LSO. Physical Therapy. NSAIDs.

Current evaluation and management of spondylolysis and spondylolisthesis.

Spondylolysis occurs with a prevalence of 4% to 6% in the general population. Although the etiology of this lesion is still unclear, it has been shown to have both hereditary and acquired risk factors, with an increased prevalence in men and athletes participating in certain high-risk sports. Spondylolisthesis occurs in a significant proportion of individuals with bilateral spondylolysis. Predicting risk factors for progression of the slip in spondylolisthesis has proven difficult. Multiple imaging techniques are helpful in the diagnosis of spondylolysis and spondylolisthesis, with recent research addressing the utility of magnetic resonance imaging in the diagnosis and management of pars lesions. The management guidelines have remained largely unchanged since early recommendations. Recently, the addition of a bone growth stimulator to the management of difficult cases has shown promise.

The nature of the spondylolytic defect. Demonstration of a communicating synovial pseudarthrosis in the pars interarticularis.

We injected methylene blue dye into 32 of the facet joints immediately above the defects in 17 consecutive patients with bilateral spondylolysis (34 defects). In 30 of these the dye flowed into a central cavity in the defect of the pars interarticularis and in 20 it passed into the facet joint below the defect. We found macroscopic cavities in 32 of the defects which communicated with the adjacent facet joints and had fibrous capsules. Histological examination showed focal areas of synovial lining consistent with a synovial pseudarthrosis. In most patients requiring surgery for spondylolysis, the defect is a synovial pseudarthrosis which communicates with the facet joint above it, and less often with the facet joint below it. We suggest that stress fractures of the pars may fail to heal because of the presence of synovial fluid from a nearby facet joint.

The nature of the spondylolytic defect

We injected methylene blue dye into 32 of the facet joints immediately above the defects in 17 consecutive patients with bilateral spondylolysis (34 defects). In 30 of these the dye flowed into a central cavity in the defect of the pars interarticularis and in 20 it passed into the facet joint below the defect. We found macroscopic cavities in 32 of the defects which communicated with the adjacent facet joints and had fibrous capsules. Histological examination showed focal areas of synovial lining consistent with a synovial pseudarthrosis. In most patients requiring surgery for spondylolysis, the defect is a synovial pseudarthrosis which communicates with the facet joint above it, and less often with the facet joint below it. We suggest that stress fractures of the pars may fail to heal because of the presence of synovial fluid from a nearby facet joint.

Symptomatic lumbar foraminal epidural varix. Case report and review of the literature

Symptomatic epidural varix is rarely described in the literature and is difficult to diagnose by CT. We present a case of symptomatic foraminal epidural varix associated with bilateral spondylolysis simulating an extreme lateral disc herniation on CT. The literature is reviewed.

Spondylolysis and spondylolisthesis: A cost of being an erect biped or a clever adaptation?

Spondylolysis refers to a separation in a vertebral arch between the body and the spinous process. Most spondylolysis seen in humans occurs in the lower lumbar region and is due to stress (fatigue) fracturing, usually through the isthmus between the superior and inferior articular processes. Referred to here as “typical” spondylolysis, it is related to erect posture and bipedal locomotion, and, as such, it is a uniquely hominid condition. It develops only after a child has begun to walk, and a developing lesion may heal or progress to complete separation. Seen more often in males than females, frequencies among populations vary widely. Certain activities have been suggested to put individuals performing them at greater risk to develop the condition. Although often approached as a pathological condition requiring corrective treatment, spondylolysis usually produces relatively mild symptoms if any at all, and may even provide the advantages of greater lower back flexibility. Complete bilateral spondylolysis separates the inferior articular processes from the body, thus allowing the body to slip forward relative to the vertebra below (spondylolisthesis). Another form of the condition, referred to as degenerative spondylolisthesis, allows a slow forward migration of one vertebra over another due to osteoarthritic remodeling of the posterior vertebral joints without any spondylolysis. © 1996 Wiley-Liss, Inc.

The spine--a problem area in high performance artistic gymnastics. A retrospective analysis of 24 former artistic gymnasts of the German A team

24 former female artistic gymnasts of the German national team were examined for spinal deformities after the end of their athletic career. In 3 cases we found osseous lesions of the spine without neurological complications. However, emphasis was on spinal changes due to stress. During their athletic career 15 gymnasts complained of low back pain which persisted in 7 of them after finishing their athletic activities. The lumbar radiographs revealed bilateral spondylolysis at L5 in 6, unilateral spondylolysis in 1, spondylolisthesis at L5/S1 in 3, degenerative changes of the intervertebral joints in 5, retrolisthesis at L5/S1 in 2, and scoliosis in 6 cases.

Spondylolysis and Spondylolisthesis in Military Parachutists

This paper reports on three cases of symptomatic low back pain in three paratroopers in association with bilateral L5 spondylolysis and L5 on S1 spondylolisthesis. The controversy regarding the etiology of this lesion as well as the problems of establishing causality when associated with parachuting injuries are discussed. These cases raise the issue of whether routine lumbar spine roentgenography should be performed as part of the pre-course medical screening prior to an individual undertaking basic parachutist training, and stress the need for further study of the relevance of these lesions in military parachuting.

Computed tomography of congenital spondylolisthesis of the sixth cervical vertebra

Congenital anomalies of the cervical spine occur relatively commonly. An interesting anomaly is congenital spondylolisthesis of the sixth cervical vertebra. We are presenting a case of this anomaly as imaged with plain radiography and computed tomography. We have also reviewed the previous literature and attempted to clarify distinctions between bilateral cervical spondylolysis with spondylolisthesis and other cervical spine lesions.

Acute Traumatic Spondylolysis

Acute traumatic bilateral spondylolysis and spondylolisthesis was observed in a 34-year-old man. The literature on pathologic and biomechanical factors leading to acute fracture of the pars interarticularis emphasizes the importance of distinguishing spondylolysis resulting from acute trauma from the more common lytic-fatigue pars defect.

Spondylolysis: what does this mean? A review.

ABSTRACTSpondylolysis is a common lesion, but its pathology and clinical significance are still not fully understood. A review of the literature on these aspects of spondylolysis is presented.Spondylolysis is probably an acquired lumbar stress fracture. When bilateral, as it commonly is, it may be complicated by spondylolisthesis. Indirect evidence suggests that spondylolysis may cause acute back pain. Isotope bone scans and radiological findings help in the clinical management of these patients.Unilateral spondylolysis does not cause chronic back pain, nor disability. Spondylolisthesis, on the other hand, may cause chronic back pain. Pain suffered by patients with bilateral spondylolysis is probably due to spondylolisthesis. Neurological complications are rare.

Atlanto-occipital fusion and spondylolisthesis in an Anasazi skeleton from Bright Angel Ruin, Grand Canyon National Park, Arizona.

The skeleton of a middle-aged female showing an unusual pattern of congenital, traumatic, and degenerative pathology was recovered from a small Kayenta Anasazi site located near the confluence of Bright Angel Creek with the Colorado River in the Inner Gorge of Grand Canyon. The atlas is fused with the base of the skull and C2 is fused with C3. The cervical region was subjected to hyperextension, perhaps through use of a tumpline, with resultant reduction of the neural canal to 8 mm, a condition that quite likely led to neurological problems. The skeleton also includes a depression fracture of the lateral condyle of the left tibia. Complete, bilateral spondylolysis of L5 led to an olisthesis of approximately 15 mm. The disc between L5 and S1 then ossified, most likely from staphylococcus bacteremia, making the olisthesis permanent and thereby creating a unique arachaeological specimen. Although spondylolysis is usually viewed as a stress fracture, the general pattern of pathology in this individual makes it necessary to consider an etiology of acute trauma.

Radiating Leg Pain and Positive Straight Leg Raising in Spondylolysis in Children

Three children presented with low back pain radiating to the leg and with spasm of the hamstring and paravertebral muscles. Since the pain could not be ascribed to trauma, it was necessary to exclude the presence of infection or tumors. All the signs--localization of the pain, tenderness on one side of the back, X-ray film findings of unilateral or bilateral spondylolysis, and localized positive bone scan--pointed to spondylolysis as the cause of pain. All three children exhibited symptoms resembling those found in the facet syndrome described by Mooney and Robertson.

Symptomatic and asymptomatic spondylolysis and spondylolisthesis in young adults.

The lumbar spine was examined radiologically for the presence of spondylolysis and spondylolisthesis in 936 asymptomatic soldiers prior to military placement and in 662 soldiers complaining of low back pain. The overall incidence of spondylolysis was 9.7% in both groups, but bilateral spondylolysis was more prone to be associated with symptoms than a unilateral defect. In the symptomatic group the incidence of spondylolisthesis was 5.3% but only 2.2% in the asymptomatic group. The defect was seen in the oblique views only in 18.7% of the cases of spondylolysis. The precise diagnosis is important for vocational counselling and military placement.

Spondylolysis Following Trauma

A 31-year-old woman who had an apparently normal lumbosacral spine, developed a unilateral spondylolysis of L4 following injury, and then one year later, roentgenographically showed a bilateral spondylolysis. The cause of spondylolysis was not established, but several theories have been proposed, the most attractive of which is that this condition represents a stress fracture through an area of bone predisposed to fracture. The classifications of spondylolysis and the etiologic theories demonstrate that this case cannot be convincingly classified according to the usual criteria. However, trauma was documented and may have been a significant etiologic factor of spondylolysis.

Facet joint arthrography in lumbar spondylolysis.

Facet joint arthrography was performed in 11 patients with lumbar spondylolysis. An abnormal communication between the two facet joints bordering the separated par interarticularis was observed in nine of these patients. This communication occurred through a channel in the area of the defect. In one patient with bilateral spondylolysis of the L5 vertebra, both left adjacent apophyseal joints were observed to communicate not only with one another, but also with the contralateral facet joints, through a transverse channel joining the isthmic areas of L5. Significant pain relief following intra-articular administration of anesthetics and corticosteroids was recorded in 5 patients, for periods lasting from 2 to 10 months. Spondylolysis considerably alters the soft tissues of the adjacent facet joints. Irritation of these structures might explain certain complaints of patients with spondylolysis.