Etiology Of Spondylolysis Research Articles

Management of lumbar spondylolysis in the adolescent athlete: a review of over 200 cases

BACKGROUNDSpondylolysis is a defect of the pars interarticularis of vertebrae, most commonly seen at L5 and L4. The etiology of spondylolysis and isthmic spondylolisthesis is generally considered to be a result of repetitive mechanical stress to the weak portion of the vertebrae. A higher incidence of spondylolysis is observed in young athletes. Symptomatic spondylolysis can be successfully treated conservatively, but there is currently a limited consensus on treatment modalities and a lack of large-scale clinical trials. PURPOSEThe purpose of the present study was to investigate the optimal treatment algorithm for symptomatic spondylolysis in adolescent athletes and evaluate the functional outcomes of those undergoing the nonoperative treatment. STUDY DESIGNA retrospective review. PATIENT SAMPLETwo hundred one adolescent patients ranging from age 10 to 19 involved in athletics OUTCOME MEASURESInjury characteristics (age, mechanism, time), sports played, bone stimulator use, bony healing at 3 months on computed tomography (CT) scans, return to sports, corticosteroid injection use. METHODSTwo hundred one adolescent athlete patients (62 females and 139 males) diagnosed with spondylolysis between 2007 and 2019 were retrospectively reviewed. Diagnosis was based on plain radiography followed by magnetic resonance imaging. All patients were treated conservatively with cessation of sports activity, thoracolumbosacral orthosis, and external bone stimulator for three months after diagnosis. CT scans were obtained for the 3-month follow-up visits to assess bony healing. Subsequently the patients received 6 weeks of rehabilitation focused on core strengthening. Symptomatic patients after the treatment were referred for steroid injections and continued with the rehabilitation protocol. RESULTSThe most common age of injury was 15 years old, following a strong normal distribution. The most commonly played sport was football, followed by baseball/softball. The primary mechanism of injury was weight training closely followed by a football injury. The first quarter of the calendar year had the highest incidence of injuries with the most injuries occurring in March and the least occurring in December. One hundred fifty-two athletes reported using bone stimulators as prescribed, and these patients showed a significantly higher rate of bony healing on follow-up CT scans than those who did not use bone stimulators. One hundred ninety-seven patients (98%) returned to sports or similar level of activities. Thirty-seven patients (18%) received facet or epidural steroid injections due to continued pain and one patient underwent a surgical procedure. Follow-up CT scans showed 49.8% bony healing. CONCLUSIONSConservative treatment of spondylolysis in adolescent athletes with cessation of sports, thoracolumbosacral orthosis, and bone stimulator followed by rehabilitation was associated with excellent outcomes in terms of return to sports.

Spondylolysis and spinal adaptations for bipedalism: The overshoot hypothesis.

Background and objectivesThe study reported here focused on the aetiology of spondylolysis, a vertebral pathology usually caused by a fatigue fracture. The goal was to test the Overshoot Hypothesis, which proposes that people develop spondylolysis because their vertebral shape is at the highly derived end of the range of variation within Homo sapiens.MethodologyWe recorded 3D data on the final lumbar vertebrae of H. sapiens and three great ape species, and performed three analyses. First, we compared H. sapiens vertebrae with and without spondylolysis. Second, we compared H. sapiens vertebrae with and without spondylolysis to great ape vertebrae. Lastly, we compared H. sapiens vertebrae with and without spondylolysis to great ape vertebrae and to vertebrae of H. sapiens with Schmorl’s nodes, which previous studies have shown tend to be located at the ancestral end of the range of H. sapiens shape variation.ResultsWe found that H. sapiens vertebrae with spondylolysis are significantly different in shape from healthy H. sapiens vertebrae. We also found that H. sapiens vertebrae with spondylolysis are more distant from great ape vertebrae than are healthy H. sapiens vertebrae. Lastly, we found that H. sapiens vertebrae with spondylolysis are at the opposite end of the range of shape variation than vertebrae with Schmorl’s nodes.ConclusionsOur findings indicate that H. sapiens vertebrae with spondylolysis tend to exhibit highly derived traits and therefore support the Overshoot Hypothesis. Spondylolysis, it appears, is linked to our lineage’s evolutionary history, especially its shift from quadrupedalism to bipedalism.Lay summary: Spondylolysis is a relatively common vertebral pathology usually caused by a fatigue fracture. There is reason to think that it might be connected with our lineage’s evolutionary shift from walking on all fours to walking on two legs. We tested this idea by comparing human vertebrae with and without spondylolysis to the vertebrae of great apes. Our results support the hypothesis. They suggest that people who experience spondylolysis have vertebrae with what are effectively exaggerated adaptations for bipedalism.

The investigation of the role of the facet joint angle in the development of L5-S1 spondylolysis in young men.

This study aims to evaluate facet tropism in younger patients with lumbar spondylolysis and to investigate the role of facet tropism in the development of spondylolysis. Between February 2013 and December 2015, a total of 102 male patients with bilateral L5 pars defect including 53 with spondylolysis and 49 control subjects were included in this case-control study. The facet joint angles were measured bilaterally and axially at the level of L3-4, L4-5, L5-S1 using computed tomography (CT). The classification was made as follows: A difference between two reciprocal facet joint angles of <6° indicated no tropism, 6°-12° indicated moderate tropism, and >12° indicated severe tropism. A total of 612 angles including 318 facet joint angles from 53 patients with spondylolysis and 294 facet joint angles from 49 control subjects were measured. L3-4 measurements in the control group showed no tropism in 87.8% (n=43), moderate tropism in 12.2% (n=6), and severe tropism in 0% (n=0). L4-5 measurements in control group showed no tropism in 79.6% (n=39), moderate tropism in 20.4% (n=10), and severe tropism in 0% (n=0). L5-S1 measurements in the control group showed no tropism in 69.4% (n=34), moderate tropism in 28.6% (n=14), and severe tropism in 2.0% (n=1). The mean facet joint angles in the spondylosis group were 32.9±5.1°, 37.5±5.4°, and 41.2±7.8° at the levels of L3-4, L4-5, and L5-S1, respectively. The mean facet joint angles of the control group were 33.2±5.7°, 39.7±4.9°, and 42.2±4.9° at the levels of L3-4, L4-5, and L5-S1, respectively, indicating no significant difference between the right and left mean facet joint angles between the groups (p>0.05). The frequency of facet tropism and the difference between right and left facet joint angles for all three levels were significantly higher in the spondylolysis group (p<0.05). Facet tropism at the level of L5-S1 was significantly more frequent than facet tropism at L3-4 level (p<0.05). Our study results show that the rate of facet joint tropism is higher in the patients with spondylolysis, suggesting that facet tropism seems to play a role in the etiology of spondylolysis as a predisposing factor.

SAT0430 Tight hamstrings of young athlete change lumbar spinal alignment kyphoscoliosis in the kick position: A new radiographic evaluation for lumbar spine in anteroposterior and lateral view under dynamic straight leg raising

BackgroundLumbar spondylolysis is very frequency disorders of young athletes, particularly those involved in baseball, football, weight-lifting, and track & field. The rate of occurrence may be greater in Japanese subjects,...

The Occurrence and Possible Aetiology of Spondylolysis in a Pre‐contact California Population

ABSTRACTThe occurrence of spondylolysis (neural arch separation at the pars interarticularis) is reported in a pre‐contact (720–550 Cal BP) Central California population, CA‐CCo‐647 (n = 46). Spondylolysis was examined within this population to assess differences in sex, age, and possible relationships with biological affinity. Furthermore, prevalence rates of spondylolysis were compared across various populations to discern the aetiology of the defect. Within CA‐CCo‐647, spondylolysis was found in 17.4% (8/46) of the population. All occurrences are complete, bilateral separations of the neural arch in the lower lumbar (L4 and L5). The defect is not seen in individuals below the age of 18, and there is no correlation between adult age and spondylolysis. Male individuals display the defect at a higher rate (30.8% ‐ 4/13) than female individuals (12.1% ‐ 4/33); however, this is not a statistically significant finding. There does seem to be a correlation between an individual's sex and the onset of the defect; male individuals display spondylolysis at a younger age than female individuals. This finding could represent differences in activity patterns among young male and female individuals. In a biological distance analysis using craniometric data, male and female individuals with spondylolysis clustered closely, suggesting a genetic component for the defect. Finally, significant differences were found in spondylolysis prevalence between various populations representing distinct geographic and temporal settings. Significant differences were found among Native pre‐contact samples and even between two comparable pre‐contact California skeletal samples. These populations all engaged in distinct activities and were likely composed of genetically distinct groups of individuals, which may account for the differences in spondylolysis prevalence. All of these findings, both within CA‐CCo‐647 and between the various samples, suggest that the aetiology of spondylolysis is likely an interaction of genes and activity. Copyright © 2012 John Wiley &amp; Sons, Ltd.

Spondylolysis in the upper lumbar spine. A study of 32 patients.

Reports of spondylolysis in vertebrae other than those of the lower lumbar spine are rare. We report 32 patients with upper lumbar spondylolysis who have been studied clinically, radiologically and scintigraphically. Twenty patients had bilateral lesions, and seven of those with unilateral lesions had structural changes or anomalies in the opposite posterior arch. Positive scans were found to be associated with a short clinical history, and indicated stress-related lesions. Our findings suggest that mechanical factors may play a role in the aetiology of spondylolysis in the upper lumbar spine similar to that which they play in the lower lumbar spine, and that local structural anomalies may contribute to abnormal loading of these vertebrae.

The importance of mechanical factors in the etiology of spondylolysis. A model analysis of loads and stresses in human lumbar spine : Dietrich M Kurowski P. Spine 1985-.10:532-42

The importance of mechanical factors in the etiology of spondylolysis. A model analysis of loads and stresses in human lumbar spine : Dietrich M Kurowski P. Spine 1985-.10:532-42

The importance of mechanical factors in the etiology of spondylolysis. A model analysis of loads and stresses in human lumbar spine.

Because the etiology of spondylolysis is not well understood, the authors performed an analysis of loads and stresses in human lumbar vertebrae to determine whether purely mechanical factors are likely to cause spondylolytic fractures in a normal spine. To perform these studies, modeling methods were applied. A mechanical system was developed to study muscle forces and reactions in joints of the lumbar spine. Next an optimization approach was applied to find loads on vertebrae and muscle forces. Finally photoelastic experiments were performed to find effective stresses and stress concentrations in low lumbar vertebrae. The analysis showed that the highest stresses appear in parts interarticularis. The results prove that factors of a purely mechanical nature are of fundamental importance in the etiology of spondylolysis.

On the initiation of spondylolysis through mechanical factors

Ever since the appearance of Neugebauer’s work, about 100 years ago, much has been written on the subject of ‘spondylolisthesis’ and ‘spondylolysis’. In spite of this, there is still no universally accepted explanation regarding the aetiology of spondylolysis, that is, the occasionally observed separation of the bone structure in the isthmus of the neural arch, and several questions have still remained unanswered.

Variations in the Amount and Distribution of Cortical Bone Across the Partes Interarticulares of L5

The possible role of the physical and mechanical properties of the neural arch as contributing factors in the etiology of spondylolysis was tested by comparing two groups of vertebral specimens obtained at necropsy. Group I specimens had been subjected to repetitive cyclic force which they withstood without fracturing. Group II specimens were randomly selected. The cross-sectional distribution of cortical and cancellous bone in the partes interarticulares were measured, and the two groups compared. The previously stressed group was found to have a greater percentage of cortical bone than the random group. The data are interpreted to suggest that thin partes interarticulares may predispose to spondylolysis through the mechanism of fatigue failure.

脊椎分離発生に関する力学的研究

脊椎分離発生に関する力学的研究

Spondylolytic fractures.

A method is described whereby fractures of the neural arch similar to those in spondylolysis are produced experimentally. The forces, bending moments and displacements required to initiate the fractures are given; The mechanical aspects in the aetiology of spondylolysis are explained by a simplified two-dimensional force analysis.

The Strength of the Neural Arch and the Etiology of Spondylolysis

The Strength of the Neural Arch and the Etiology of Spondylolysis