Spondylolysis Research Articles

The efficacy and complications of minimally invasive vs. the traditional open transforaminal lumbar interbody fusion for the treatment of lumbar spondylolisthesis

Objective To investigate the clinical efficacy and complications of minimally invasive transforaminal lumbarinterbody fusion (TLIF) in the treatment of lumbar spondylolisthesis. Methods Total 142 patients with single level spondylolisthesis who treated by TLIF from 2010.01 to 2015.06 were included in this study, with 68 cases in minimally invasive TLIF (MIS-TLIF) group and 74 cases in traditional open TLIF group. The general information (age, gender, isthmic or degenerative type, percentage of slip degree, levels), operative time, blood loss, length of postoperative hospital stay, Visual Analogue Scale (VAS) of lowback pain and leg pain, and Oswestry Disability Index (ODI) were recorded and collected. The posterior height of the intervertebralpace and segmental lordosis, reduction of spondylolisthesis and cross-sectional area of spinal canal were measured. Results There was no statistically significant difference between the two groups in age, gender ratio, percentage of slip degree, and surgicallevels distribution. Total of 66 cases in MIS-TLIF group and 71 cases in Open TLIF group finished 2 years follow up, and 25 cases in MIS-TLIF group and 31 cases in Open TLIF group finished 5 years follow up. The blood loss of the MIS-TLIF group was 164.7±51.7 ml, significantly lower than the open TLIF group of 239±69.3 ml(P<0.001). The length of postoperative hospital stay was 5.9±1.5 days in MIS-TLIF group, significantly shorter than the open TLIF group of 7.3±3.1 days(P<0.001). The operative time of MIS-TLIF and Open TLIF was 146.3±21.9 mins, 152.0±20.4 mins, respectively, and no significant difference was found between them. The VAS ofback pain, leg pain, ODI in MIS-TLIF group was 1.76±1.16, 1.91±1.36 and 23.5±7.3 at 2 years follow up, and in Open TLIF was 1.73±1.10, 1.83±1.36 and 23.8±6.7, respectively, all of them were significantly different to pre-operation, however, no significant difference was found between two groups. The VAS of back pain, leg pain, ODI in MIS-TLIF group was 1.73±1.21, 1.93±1.48, and 25.4±6.8 at 5years follow up, and in Open TLIF was 1.85±1.02, 1.85±1.33 and 26.1±6.5, respectively, no significant difference between twogroups. The posterior height of the intervertebral space and segmental lordosis of MIS-TLIF was 9.52±1.67 mm and 12.11°±3.44° at 2 years follow up, while the open TLIF was 9.88±1.54 mm and 12.98±3.83°, all of them were significantly different to pre-operation,however, no significant difference between two groups. The posterior height of the intervertebral space and segmental lordosis of MIS-TLIF was 9.37±1.46 mm and 11.55°±2.77°, while the open TLIF was 9.66±1.68 mm and 12.59°±4.23°, no significant difference between two groups. The percentage of slip degree was reduced to 5.2%±4.6% in MIS-TLIF and 5.6%±4.3% in open TLIF, the cross-sectional area of spinal canal was enlarged to 139.7±19.5 mm2 and 141.7±20.7 mm2, no significant difference between two groups either. Conclusion MIS-TLIF has less blood loss, shorter postoperative hospital stay than open TLIF, and similar clinical pain and functional outcomes. MIS-TLIF is suggested to be a safe and effective choice in the treatment of lower grade lumbar spondylolisthesis(Grade II or less). Key words: Lumbar vertebrae; Spondylolysis; Surgical procedures, minimally invasive; Spinal fusion

Stand-alone anterolateral lumbar interbody fusion for degenerative spondylolisthesis

Objective To evaluate the clinical outcome of anterolateral lumbar interbody fusion (ALLIF) for the treatment of degenerative lumbar spondylolisthesis(DLS). Methods All of 53 patients with degenerative spondylolisthesis were enrolled in this study during January 2014 to January 2016. All patients underwent stand-alone ALLIF with self-locked cage, including 15 males and 38 females with an average of 57.4±11.2 years old. The surgical level included L3,4(4 cases), L4,5(33 cases) and L5S1(16 cases). The operative time, bleed loss and complications were recorded. Clinical outcome was measured by visual analogue scale (VAS), Oswestry disability index (ODI) and the health questionnaire (SF-36). Radiological measures were slippage, disc height, lumbar lordosis, sagittal diameter and area of dural canal, foraminal height and area, and fusion rate. All the data were statistically analyzed. Results All patients were followed up for at least 24 months. The mean operation time was 64.2±12.5 minutes, and the mean bleed loss was 72.8±14.3 ml. No serious complications such as vascular or nerve injury occurred during peri operation. VAS for low back pain, VAS for leg pain and ODI were significantly decreased from 6.8±1.5, 5.6±2.4 and 58.5%±18.6% preoperatively to 1.6±1.2, 1.2±1.1 and 18.5%±8.8% at 24 months postoperatively. The SF-36 scores were improved significantly from 56.7±12.8 preoperatively to 79.4±14.3 at 24 months postoperatively. Slippage of patients was reduced significantly from 22.5%±8.3% preoperatively to 5.7%±2.3%. Disc height and lumbar lordosis were significantly increased from 6.2±1.6 mm and 46.4°±9.2° preoperatively to 10.5±1.4 mm and 53.2°±11.2° at 24 months postoperatively. Sagittal diameter and cross-sectional area of thecal sac were significantly increased from 11.7±2.2 mm and 78.4±28.6 mm2 preoperatively to 13.8±1.6 mm and 112.5±23.9 mm2 at 6 months postoperatively. Intervertebral foramina height and area were significantly increased from 15.8±4.3 mm and 136.5±25.6 mm2 preoperatively to 19.2±2.5 mm and 157.6±23.1 mm2 at 6 months postoperatively. At 24 months follow-up, the fusion rate was 100% and the subsidence rate was 10.5%. Conclusion Stand-alone ALLIF could achieve satisfactory clinical results and reduction for DLS. Disc height and lumbar lordosis were restored. Efficient decompression was obtained with significantly increased sagittal diameter and cross-sectional area of thecal sac and intervertebral foramina height and area. Stand-alone ALLIF provides a new surgical strategy for the treatment of DLS. Key words: Lumbar vertebrae; Spondylolysis; Surgical procedures, minimally invasive; Spinal fusion

Segmental Lordosis of the Spondylolytic Vertebrae in Adolescent Lumbar Spondylolysis: Differences between Bilateral L5 and L4 Spondylolysis.

Study DesignRetrospective study.PurposeThis study aimed to investigate whether segmental lumbar hyperlordosis of the affected vertebra in patients with spondylolysis occurs only at L5 or also occurs at L4.Overview of LiteratureTo the best of our knowledge, increase in segmental lordosis of the spondylolytic vertebrae has only been investigated in bilateral L5 spondylolysis; it has not been examined at different levels of bilateral spondylolysis. According to the characteristics of segmental lordosis in bilateral L5 spondylolysis, patients with bilateral L4 spondylolysis may also have increased segmental lordosis of the L4 vertebra.MethodsPatients with bilateral spondylolysis of the L5 or L4 vertebra in 2013–2015 were retrospectively identified from the hospital database. Standing lateral lumbar radiographs were assessed for the angle of segmental lordosis of the L5 and L4 vertebra, sacral slope, and lumbar lordosis. The differences in segmental lordosis of the L5 and L4 vertebra, sacral slope, and lumbar lordosis were determined using non-paired Student t-test.ResultsOverall, 15 cases of bilateral L4 spondylolysis and 41 cases of bilateral L5 spondylolysis satisfied the inclusion and exclusion criteria. Lordosis of the L4 vertebra was significantly greater in the bilateral L4 spondylolysis group (24.2°±7.0°) than that in the L5 spondylolysis group (20.3°±6.1°, p=0.047). Lordosis of the L5 vertebra was significantly lower in the L4 spondylolysis group (27.7°±8.2°) than that in the L5 spondylolysis group (32.5°±7.3°, p=0.040). The sacral slope and lumbar lordosis did not significantly differ between the groups.ConclusionsAdolescent patients with bilateral spondylolysis have segmental hyperlordosis of the affected vertebra not only at the L5 level but also at the L4 level.

Chronic Lumbar Spondylolysis in an Adolescent Hockey Player

Lumbar spondylolysis is an underreported condition in adolescents who play the sport of ice hockey. Managing spondylolysis in a growing adolescent proves to be challenging in regard to sport restrictions and return to play. Advanced imaging, including magnetic resonance imaging (MRI) or single-photon emission computed tomography (SPECT), should be acquired in order to reach a faster definitive diagnosis. Some cases may lead to a chronic form of spondylolysis that requires patience from the provider, the patient, and the patient’s family.

Development of vibrational analysis for detecting early-stage spondylolysis in adolescent male football players

Background: Lumbar spondylolysis refers to a fracture of the vertebral pars interarticularis and is a common disease in adolescent athletes. While the fracture may heal during the early stages of spondylolysis, healing is difficult in advanced stages. Thus, early diagnosis of spondylolysis is necessary to promote healing. Bone fractures can be detected by analyzing vibrational signals following bone stimulation. This vibrational analysis can also be applied to detect stress fractures, including spondylolysis. This study aimed to investigate whether vibrational analysis can be used to detect spondylolysis in adolescent male football players.

Dash-Associated Spondylolysis Hypothesis.

Introduction In past biomechanical studies, repetitive motion of lumbar extension, rotation, or a combination of both, frequently seen in batting or pitching practice in baseball, shooting practice in soccer, and spiking practice in volleyball, have been considered important risk factors of lumbar spondylolysis. However, clinically, these have been identified in many athletes performing on a running track or on the field, which requires none of the practices described above. The purpose of this study was to verify how much impact running has on the pathologic mechanism of lumbar spondylolysis. Methods In study 1, 89 consecutive pediatric patients diagnosed with lumbar spondylolysis at a single outpatient clinic between January 2012 and February 2017 were retrospectively analyzed. In study 2, motion analysis was performed on 17 male volunteers who had played on a soccer team without experiencing low back pain or any type of musculoskeletal injury. A Vicon motion capture system was used to evaluate four movements: maximal effort sprint (Dash), comfortable running (Jog), instep kick (Shoot), and inside kick (Pass). Results In study 1, 13 of the 89 patients with lumbar spondylolysis were track and field athletes. In study 2, motion analysis revealed that the hip extension angle, spine rotation angle, and hip flexion moment were similar in Dash and Shoot during the maximum hip extension phase. The pelvic rotation angle was significantly greater in the kicking conditions than in the running conditions. Conclusions Kinematically and kinetically, the spinopelvic angles in Dash were considered similar to those in Shoot. Dash could cause mechanical stress at the pars interarticularis of the lumbar spine, similar to that caused by Shoot, thus leading to spondylolysis.

Management of Lumbar Spondylolysis in Athletes: Role of Imaging

Spondylolysis is a broad term, with advances in imaging enabling more accurate diagnosis of the activity and severity of a lesion. This review discusses the role of different imaging modalities in the diagnosis and management of lumbar spondylolysis in athletes. Magnetic resonance imaging (MRI) has diagnostic and practical advantages over other imaging modalities and is particularly useful for detecting early stages of bone stress, including pre-symptomatic screening for active lumbar bone stress injuries. Whilst computed tomography remains the best imaging technique to visualise cortical breaches, specialised MRI sequences offer a viable alternative to detect active bone stress and chronic non-united defects. Imaging provides important information for the clinical management of athletes with lumbar spondylolysis. Roles for imaging, in particular MRI, include: (a) proactive screening and early detection, (b) diagnosis of a symptomatic lesion and (c) monitor healing and readiness to return to sport.

Bony Healing of Discontinuous Laminar Stress Fractures Due to Contralateral Pars Defect or Spina Bifida Occulta.

Introduction Although there has been a dramatic improvement in the outcomes of conservative treatment to achieve bony healing due to advances in diagnostic and therapeutic tools, in some patients, the results continue to be unfavorable. The purpose of this study was to investigate the outcomes of conservative treatment in pediatric patients with stress fractures occurring in the lamina that are discontinuous due to a contralateral pars defect or spina bifida occulta (SBO). Methods The medical records at our outpatient clinic for 103 consecutive patients (83 boys, 20 girls) with lumbar spondylolysis (LS) were reviewed to identify those who had presented with a stress fracture and a contralateral pars defect or with SBO at the affected lamina level. Results Twelve patients (11 boys, 1 girl) of mean age 12.3 (range 8-16) years were identified. Except for 1 stress structure that occurred at L4, all the stress fractures occurred at L5. Six patients had a pars defect, 5 had SBO, and 1 had both. Two of the 6 patients with a contralateral pars defect had early LS, 3 had progressive LS, and 1 had a pedicle fracture. The fracture healed in 1 (50%) of the 2 patients with early LS and in the patient with the pedicle fracture, but did not heal in any of the patients with progressive LS. Two of the 5 patients with SBO at the affected lamina level had early LS and 3 had progressive LS. The bony healing rate was 100% in the 2 patients with early LS and 66.7% in the 3 patients with progressive LS. The fracture healed in the patient with progressive LS and both a pars defect and SBO at the affected lamina. Conclusions Contralateral pars defect remains an unfavorable factor for bony healing discontinuous laminar stress fractures.

Lumbar intervertebral disc degeneration in professional surfers

Summary Background Surfing was added as an official event of the Tokyo Olympics in 2020. There are many surfers troubled by low back pain, but there is no scientific analysis until now. This time, we took MRI on the lumbar vertebrae in 20 official professional surfers and examined the relationship between the low back pain and the rate of the lumbar disc degeneration. Materials and methods Subjects are 20 people (16 men, 4 women) of 17 Japan official professional surfers and 3 Japan official professionals bodydoaders in total, average age 29.8 years old (17–57 years), we investigated by use of the lumbar vertebrae T2-weighted magnetic resonance imaging. Results 11 people (55%) had the low back pain, 10 people (50%)had the lumbar disc degeneration (more than Grade III of Pfirrmann classification), 2 people (10%) had the lumbar spondylolysis. There is no relationship between the low back pain and the rate of the disc degeneration. Conclusions The prevalence rate of low back pain in the professional surfers was approximately equal to previous report. The prevalence rate of the lumbar disc degeneration was 50%, and it was not high rate particularly in comparison with baseball and the swimming. The surfing competition is easy to cause the low back pain, but is not easy to cause the disc degeneration.

Is the Scotty Dog Sign Adequate for Diagnosis of Fractures in Pediatric Patients with Lumbar Spondylolysis?

Introduction Recent advances in diagnostic imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), have allowed early diagnosis of lumbar spondylolysis (LS). However, few outpatient clinics are equipped with such imaging apparatuses and must rely on plain radiographs for the diagnosis of LS. The aim of this retrospective study was to identify how accurately fracture lines can be detected on plain radiographs in patients with LS. MethodsPatients with a diagnosis of LS were staged as early, progressive, or terminal. We evaluated whether fracture lines could be detected on plain radiographs and compared the detection rates under the following conditions: two directions including anteroposterior and lateral views (2 views), four directions including both oblique views (4 views), four directions including dynamic lateral views (4-D views), and all six directions (6 views). Results In early LS, the fracture line detection rate was 11.4% using 2 views, 20.5% using 4 views and 4-D views, and 22.7% using 6 views. In progressive LS, the fracture line detection rate was 54.2% using 2 views, 70.8% using 4-D views, 75.0% using 4 views, and 79.2% using 6 views. The respective detection rates for terminal LS were 85.0%, 100%, 100%, and 100%. Conclusions Although terminal LS was diagnosed accurately on plain radiographs in all patients, the detection rates were only 22.7% and 79.2% in patients with early and progressive LS, respectively. These results suggest that plain radiographic films can no longer be considered adequate for early and accurate diagnosis of LS. Advanced imaging procedures, such as MRI in the early diagnosis or CT for persistent cases, are recommended to obtain an accurate diagnosis of early stage LS in pediatric patients requiring conservative treatment to achieve bony healing.

Radiographic analysis of the listhesis associated with lumbar isthmic spondylolysis.

In cases of spondylolysis, hypoplasia of L5 mimicking spondylolisthesis has been described, mainly based on MRI; however, the treatment implications have not been analyzed specifically. Assess the impact of hypoplasia of the L5 vertebral body in the constitution of the spondylolisthesis associated with isthmic spondylolysis. A retrospective radiographic study in the standing position was performed with 104 patients with L5 isthmic spondylolysis and 24 control subjects. Measurements of vertebral endplate length showed that the standard apparent posterior listhesis (APL) is made up of true listhesis (TL) and false listhesis (FL). FL is induced by hypoplasia of the L5 vertebral body relative to the S1 endplate. TL results from disk failure and leads to anterior listhesis (AL), which alters the balance of spinal curvatures. By integrating the potential for false listhesis into the classification systems for spondylolisthesis, we can adapt the treatment algorithms. Retrospective radiography study. IV Retrospective review of cases.

Outcome of Conservative Management in the Treatment of Symptomatic Spondylolysis and Grade I Spondylolisthesis

Purpose: Bracing, thoraco-lumbar-sacral orthosis (TLSO), has been accepted as mainstay of treatment for symptomatic spondylolysis (SP) and grade I spondylolisthesis (SPL1). However increasing costs and patient noncompliance can make bracing prohibitive and difficult to manage. The purpose of our study was to determine if SP and SPL1 can be effectively treated using physical therapy and other non-bracing conservative management techniques in order to relieve pain and restore physical function. Methods: We performed a …

Double-level lumbar spondylolysis and spondylolisthesis: A retrospective study

BackgroundLumbar spondylolysis and isthmic spondylolisthesis are common conditions. However, double-level lumbar spondylolysis and spondylolisthesis are rare. We report 24 cases of it along with a review of literature and a briefly description of the clinical and radiological features and integrated management of patients with this condition.MethodsOf 1700 inpatients diagnosed with lumbar spondylolisthesis at our hospital between January 2008 and September 2015, we selected those with a diagnosis of double-level spondylolisthesis who underwent surgery. We analyzed the data regarding age, sex, and heavy physical labour. Japanese Orthopaedic Association (JOA) and Visual Analog Scale (VAS) scores were used to evaluate preoperative and postoperative neurological function and back pain. All patients underwent decompression, reduction, and posterior lumbar interbody fusion (PLIF) with autogenous bone chips from posterior decompression or with a cage. After the operation, we were followed up for more than 2 years to observe the effect of the operation. In the meantime, the height of the intervertebral discs was measured at follow-up, and all data are analyzed in SPSS stastic.ResultsDouble-level spondylolisthesis occurred at the L2/L3 and L3/L4 levels in one patient, L3/4 and L4/L5 levels in 11 patients, and L4/L5 and L5/S1 levels in 12 patients. Nine patients also had spondylolysis. Twenty patients underwent posterior lumbar interbody fusion and internal fixation with autologous bone chip, and 4 of them underwent cage and autogenous bone graft fixation. Postoperatively, the major symptoms (neurological dysfunction and low-back pain) improved significantly. Comparison of JOA and VAS scores indicated effective recovery of neurological function (p < 0.05). Postoperative follow-up demonstrated satisfactory interbody fusion and pars interarticularis healing.ConclusionsDouble-level lumbar spondylolysis and spondylolisthesis occurred more often in women. Most common site of double lumbar spondylolisthesis was L3–L5. The treatment principle was the same as that for single-level spondylolisthesis, but the reset order is questionable. Both, posterior lumbar interbody fusion (PLIF) with autogenous bone chips from posterior decompression or with cage can relieve discomfort in most patients. In our follow-up, we found that there was a high degree of loss in disk height when autogenous bone was used. Therefore, we suggest the use of a cage.

THE “PENDULUM LAW” - HOW TO EXPLAIN THE COLUMN SHAPE BASED ON COMMON ANOMALIES? PART II

ABSTRACT In Part I, the author defines an organizational law of the body schema: the “pendulum law”, describing an ideal biomechanical structure of the spine. Thus, he shows how the common variations and anomalies, whether isolated or associated, modify the standard biomechanical scheme. The variations of isolated “curl/roll up” of the sacrum. Anomalies of the lumbosacral joint in the sagittal (LSS) and/or rotational (LSR) plan. Anomalies of stabilization of the capsule of the hip joint and the sacro-diaphyseal angle. Specific anomalies with grade 1 spondylolysis (SL). Segmental anomalies of the vertebral discs in flexion (Rx). Associated anomalies (SL + Rx + ASL= Rx). The interest of studying the impact on the vertical construction of the vertebral column, according to the “ideal” scheme is to establish the physiological limits of this gravitational law, to identify the anomalies, to classify schemes and types, and the biomechanical degenerative consequences.

Spondylolysis repair using a pedicle screw hook or claw-hook system. -a comparison of bone fusion rates-

Introduction To assess the bone fusion rates and clinical results of two surgical methods (pedicle screw claw-hook fixation and pedicle screw hook fixation) of lumbar spondylolysis repair. Methods A multicenter database of surgical patients with lumbar spondylolysis was reviewed. All patients < 20 years old with a minimum of 6 months of follow-up and computed tomography images were included. Operation time and blood loss amount were investigated. Visual analogue scale (VAS; 0-10) scores for lower back pain were evaluated to assess clinical results. Results A total of 17 patients met the inclusion criteria. Pedicle screw hook fixation was performed in five patients (the hook group), and pedicle screw claw-hook fixation was performed in 13 patients (the claw-hook group). One patient was included in both groups because each method was performed at different lumbar levels (L4 and L5). The bone fusion rates at 3, 6, and 9 months after surgery were significantly higher in the claw-hook group than those in the hook group. Operation time and blood loss amount were not significantly different between the groups. VAS scores improved in the claw-hook group but not in the hook group because of a small number of patients. Conclusions Pedicle screw claw-hook fixation was more effective than pedicle screw hook fixation in terms of bone fusion rates.

Osteoid Osteoma Can Occur at the Pars Interarticularis of the Lumbar Spine, Leading to Misdiagnosis of Lumbar Spondylolysis

Patient: Male, 18Final Diagnosis: Osteoid osteomaSymptoms: Low back painMedication: —Clinical Procedure: OperationSpecialty: Orthopedics and TraumatologyObjective:Rare diseaseBackground:Osteoid osteomas are benign bone-forming tumors characterized by local inflammation and pain. They are also characterized by a small osteolytic lesion (nidus). Spondylolysis is a defect of the pars interarticularis, which may lead to stress fractures, and is a common cause of low back pain in adolescence. Osteoid osteoma occurs predominantly in the posterior elements of the spine. Magnetic resonance imaging (MRI) signal abnormality suggesting bone marrow edema is a common finding in osteoid osteoma and early-stage spondylolysis without prominent defect.Case Report:An 18-year-old male was suffering from low back pain. He was diagnosed with lumbar spondylolysis on initial MRI and computed tomography (CT). Subsequent thin-slice CT demonstrated a nidus at the pars interarticularis, and variously-sliced MRI could detect widespread bone marrow edema. On the diagnosis of an osteoid osteoma, the nidus and surrounding osteosclerosis were resected. The patient’s pain disappeared after surgery.Conclusions:Osteoid osteoma in the pars interarticularis can be difficult to diagnosis, because MRI and CT findings for osteoid osteoma at the pars interarticularis are similar to those of the lumbar spondylolysis. The possibility of osteoid osteoma should be kept in mind when examining adolescents with low back pain.

Different Fusion Approaches for Single-level Lumbar Spondylolysis Have Similar Perioperative Outcomes.

Retrospective cohort study OBJECTIVE.: The aim of this study was to compare perioperative adverse events for patients with lumbar spondylolysis treated with transforaminal lumbar interbody fusion (TLIF), posterior spinal fusion (PSF), combined anterior and posterior fusion (AP fusion), or anterior lumbar interbody fusion (ALIF). Previous cohort studies have shown similar long-term outcomes for different surgical approaches for this indication, but potential differences in 30-day perioperative adverse events have not been well characterized. The present study uses data extracted from the American College of Surgeons National Surgical Quality Improvement Database. Patients undergoing fusion with different approaches for lumbar spondylolysis were identified. Propensity score matching was utilized to account for potential differences in demographic and comorbidity factors. Comparisons among perioperative outcomes were then made among the propensity score-matched study groups. Of 1077 cases of spondylolysis identified, 556 underwent TLIF, 327 underwent PSF, 108 underwent AP fusion, and 86 underwent ALIF. After propensity score matching, there were no differences in the rates of any of the 30-day individual adverse events studied and no differences in the aggregated groupings of any adverse event, serious adverse event, or minor adverse event. There was a significantly increased operative time in the AP fusion group, but there were no differences in hospital length of stay or readmission rates. Because perioperative adverse event rates were similar, even with a slightly longer operative time in the AP fusion group, these findings suggest that surgeon preference and long-term outcomes are better used to determine the recommendation of one surgical approach over another for single level fusions for lumbar spondylolysis. 3.

Prevalence of curable and pseudoarthrosis stages of adolescent lumbar spondylolysis.

Objective: The aim of this study was to determine the prevalence of curable and pseudoarthrosis stages of adolescent lumbar spondylolysis under high school students complaining of and seeking medical consultation for low back pain.Patients and Methods: We analyzed age, sex, morbidity, presence of spina bifida occulta (SBO), and competitive sport discipline of patients with lumbar spondylolysis. We then stratified their pathological stage using a modified classification system via magnetic resonance imaging and computed tomography.Results: Of 507 patients, 451 lesions in 268 patients were diagnosed with lumbar spondylolysis (average age, 14.7 years; sex ratio, 215:53 male/female). Morbidity levels were as follows: L1, 1 lesion in 1 patient; L2, 9 lesions in 5 patients; L3, 38 lesions in 25 patients; L4, 106 lesions in 74 patients; L5, 297 lesions in 189 patients, and SBO verified in 111 patients. A total of 264 patients played a specific sport: baseball, 93; soccer, 49; volleyball, 21; track and field, 21; basketball, 20; others, 164. The prevalence of curable- and pseudoarthrosis-stage lumbar spondylolysis was 206 lesions in 142 patients, and 141 lesions in 87 patients, respectively.Conclusion: With 59.3% of patients having curable-stage lumbar spondylolysis, adolescent athletes with low back pain are urged to seek consultation. Furthermore, clinicians should perform magnetic resonance imaging to avoid misdiagnosis.

Physical features of pediatric patients with lumbar spondylolysis and effectiveness of rehabilitation.

The purpose of this study was to evaluate the physical features of pediatric patients with lumbar spondylolysis (LS), factors that increase the load during compensatory movements at the lumbar spine, and the outcomes of rehabilitation. Twenty patients were included. Fifteen items were used:fingertip-to-floor distance (FFD), straight leg raising (SLR), heel-to-buttock distance (HBD), tightness of the rectus femoris, the lateral and medial rotator muscles, iliopsoas, tensor fascia lata, adductor muscles, soleus muscle, and latissimus dorsi, and trunk rotation, sit-ups and endurance of the abdominal and back muscles. Initial findings were judged as positive or negative using previously reported cut-off values and were re-evaluated 2 or 3 months later. Positive tests were found for HBD and tightness of the rectus femoris in 85% of the patients, for endurance of the abdominal muscles in 75%, SLR and sit-ups in 70%, and FFD and tightness of the external rotator muscles in 60%. The physical features varied according to the type of sport played, and some patients were refractory to rehabilitation. Only 17.6%, 33.3%, and 40.0% of patients with initially positive findings for HBD, tightness of the external rotator muscles, and endurance of the abdominal muscles, respectively, achieved improvements after rehabilitation. J. Med. Invest. 65:177-183, August, 2018.

Vibration Signal Analysis for Detecting Early-Stage Lumbar Spondylolysis Using Synthetic Bone

Bone fractures can be detected by analyzing vibration signals following bone stimulation. This method can also be applied to detect stress fractures, such as spondylolysis. The aim of this study was to investigate whether vibration signal analysis can be used to detect lumbar spondylolysis in synthetic bone. Four synthetic spondylolysis models of the fifth lumbar vertebra (Sawbones, product No. SAW1352-10: Malmö, Sweden) were prepared, with the following conditions: intact, unilateral defect, and bilateral defect. Unilateral defects were created by making an incision of either half the diameter (50% incision) or the entire diameter (100% incision) in length through the pars interarticularis or pedicle. Bilateral defects were created by making an additional incision of half the diameter in length on the opposite side of the defected pars interarticularis or pedicle (50% + 100% incision). Hammering was performed five times on each spinous process of the fixed synthetic bones and vibration signals were measured using an accelerometer attached to the contralateral side of the hammer. Signals were analyzed using fast Fourier transform. The parameters analyzed included the mean power frequency, first power minimum frequency (the minimum value between the first and second peaks), spectral areas of low and high frequency bands, and the relative ratio between the spectral areas of low and high frequency bands. The relative ratio was significantly lower in the 50%, 100%, and 50% + 100% incision conditions compared to the intact condition (p < 0.01), suggesting the potential utility of vibration signal analysis in diagnosing lumbar spondylolysis.