Spondylolysis In Children Research Articles

Lumbar Spondylolysis in Ambulant Children with Spastic Cerebral Palsy.

Lumbar spondylolysis is a common condition; nonetheless, its cause in patients with spastic cerebral palsy (CP) remains unknown. Furthermore, examination of children with CP may not accurately capture complaints, thus causing diseases to be overlooked. Understanding the clinical features and gait patterns of lumbar spondylolysis in CP can aid in diagnosis. This study aimed to identify the clinical features and specific gait patterns of lumbar spondylolysis in ambulatory children with CP. Seventy-three children with CP were divided into two groups according to the presence or absence of lumbar spondylolysis on X-ray and magnetic resonance imaging. Three-dimensional gait analysis (3DGA) was performed to evaluate the kinematic data of the lower limbs. Eight participants (11.4%) had lumbar spondylolysis primarily affecting the L5 vertebra. The lumbar spondylolysis group had a higher body weight and Body Mass Index, along with a smaller left popliteal angle on the spastic side. In 3DGA, detailed kinematic data indicated significant group differences in the mean angles of hip internal rotation (39.6° vs. 20.2°) during an entire gait cycle. The gait profile score was 19.7° in the lumbar spondylolysis group and 14.9° in the spinal uninvolved group; the difference in gait profile score between the two groups showed a minimal clinically important difference of 2.75. The overall gait profile score revealed that the gait of the lumbar spondylolysis group was deteriorated. Excessive internal rotation of the hip during gait might be a contributing factor to lumbar spondylolysis in children with CP.

Conservative treatment for lumbar spondylolysis in children of elementary school age

PurposeLumbar spondylolysis in children of elementary school age has different characteristics from those of junior or senior high school patients. The purpose of the present study was to investigate the outcomes of conservative treatment for lumbar spondylolysis in patients of elementary school age. MethodsWe included 46 lesions in 32 consecutive patients of elementary school age with fresh cases of lumbar spondylolysis (5 girls and 27 boys; mean age, 11.3 years). We examined the relationship between bone union after conservative treatment and factors such as the CT axial staging, whether the lesion was unilateral or bilateral, whether the contralateral lesion was terminal stage, and the presence of spina bifida occulta. ResultsBone union was achieved in 33 lesions (72%) in 23 patients, whereas 13 lesions (28%) in 9 patients could not obtain bone union. The proportion of unilateral lesions with bone union was 13 of 13 (100%), significantly higher than that for bilateral lesions (20/33 lesions, 61%, p = 0.009). Of the 33 bilateral lesions, bone union was attained in 20 of 28 (71%) lesions without contralateral terminal stage, whereas bone union was not attained in any of 5 (0%) lesions with contralateral terminal stage, showing a significant difference between those with or without contralateral terminal stage (p = 0.005). ConclusionBilateral lesions and contralateral terminal stage are possible unfavorable factors to bone union in conservative treatment for patients of elementary school age with lumbar spondylolysis. Early diagnosis and treatment before the lesions become bilateral or progressive stage are important.

Prevalence of Incidentally Detected Spondylolysis in Children.

PurposeTo assess the prevalence of incidentally detected lumbar spondylolysis in children.Materials and MethodsWe retrospectively reviewed the data of 809 patients under the age of 11 years (mean age, 7.0 ± 2.7 years; boys:girls = 479:330) who underwent abdominal and pelvic CT between March 2014 and December 2018. We recorded the presence, level, and laterality (unilateral or bilateral) of spondylolysis. Patients were divided into two groups based on the presence of spondylolysis: the spondylolysis (SP) and non-SP groups.ResultsIn total, 21 cases of spondylolysis were detected in 20 patients (20/809, 2.5%). The mean age of the SP group was higher than that of the non-SP group (7.8 ± 1.8 vs. 6.9 ± 2.7 years, p > 0.05). The prevalence of spondylolysis in boys was higher than that in girls (15/479 [3.1%] vs. 5/330 [1.5%], p > 0.05). The prevalence of spondylolysis in school-age children (6–10 year olds) was higher than that in preschool-age children (0–5 year olds) (17/538 [3.2%] vs. 3/271 [1.1%], p > 0.05). L5 was the most common level of spondylolysis (76.2%); one 8-year-old boy had twolevel spondylolysis. One case of isthmic spondylolisthesis was detected in a 10-year-old boy (1/809, 0.1%). There were 11 unilateral spondylolysis cases (11/21, 52.4%).ConclusionIn our study, the prevalence of spondylolysis in children under the age of 11 was 2.5%. The prevalence was higher in boys than in girls and in school-age than in preschool-age children, despite the lack of any statistically significant differences.

Pedicle Stress Injury in Children and Adolescents With Low Back Pain.

A cross-sectional, retrospective cohort study. To examine the prevalence of the pedicle stress injury, spondylolysis in children and adolescents with low back pain. And secondly, to test the hypothesis that these pathologies are associated with lumbar lordosis angle. The prevalence of the pedicle stress injury has not been investigated in children with low back pain. In recent studies, lumbar lordosis angle was associated with spondylolysis, on the other hand the pedicle stress injury was not investigated yet. In this retrospective study, 789 consecutive lumbar magnetic resonance imaging under 18 years of age were reviewed between January 2015 and July 2018. Seven hundred magnetic resonances imaging among them were included in the study (mean age: 14.87 ± 2.41 yrs; range: 4-17). Prevalence of spondylolysis, spondylolisthesis, pedicle stress injury, pedicle deformation, disc degeneration, and increased lordosis was investigated and compared in terms of sex. The relationship between increased lordosis and other pathologies was evaluated with risk ratio. Nominal variables were evaluated between the two groups using chi-square, Mann-Whitney U test. Prevalence of pedicle stress injury (12.7%), spondylolysis (8.7%), spondylolisthesis (4.1%), pedicle deformation (3.1%), disc degeneration (24%), increase in lordosis (17.4%) was found. Spondylolysis and pedicle injury were more frequent in males (P = 0.025, P < 0.001, respectively). Increased lordosis was more frequent in females (P < 0.001). Pedicle stress injury was frequently observed between 13 to 17 years and often an isolated lesion (69.6%). Spondylolysis, spondylolisthesis, pedicle deformity were more frequent in increased lordosis (P < 0.001), whereas pedicle injury frequency was not found to be different (P = 0.997). Pedicle stress injury is a common cause of back pain under 18 years of age, more common in males, and often an isolated lesion. No relationship was found between pedicle stress injury and increased lordosis, unlike other pathologies. 3.

Athletic Participation in Children with Symptomatic Spondylolysis in the New York Area

The purpose of this study was to assess athletic activities associated with spondylolysis in children and adolescents in a New York metropolitan tertiary referral center. We retrospectively evaluated 137 consecutive cases of symptomatic spondylolysis presenting to one of two pediatric orthopedic spine surgeons. Ten patients who did not participate in any organized athletics were excluded, leaving 127 children for analysis. Data regarding spondylolysis and athletic participation were gathered for analysis. One hundred and twenty-seven patients were analyzed (mean age, 13.9 ± 2.2 yr). All patients had initial x-rays, with nearly all obtaining further advanced level imaging to confirm the diagnosis of spondylolysis. Magnetic resonance imaging was obtained in 42.5% of cases, limited computed tomography scan in 29.1% of cases, and single-photon emission computed tomography scan in 23.6% of cases. The most common location of spondylolysis was at the L5 level (74%), of which 43.6% were bilateral. Of the overall cohort, 2.4% had spondylolysis at multiple levels. The most common athletic activities associated with spondylolysis in this cohort were soccer (19.3%), basketball (17.2%), and lacrosse (9.4%). Although previous reports have implicated participation in various sports in the development of symptomatic spondylolysis in children, lacrosse and baseball have rarely been associated with spondylolysis. We found that in the New York metropolitan area, soccer, basketball, lacrosse, baseball, tennis, and football were most commonly associated with spondylolysis. Therefore, we emphasize consideration of spondylolysis in these children if they present with low back pain. These results may be used to counsel parents and young athletes about the possibility of spondylolysis as an etiology of lumbar back pain and in educating coaches, teachers, school nurses, and primary care providers.

MRI Signal Changes of the Pedicle as an Indicator for Early Diagnosis of Spondylolysis in Children and Adolescents

Clinical review of pediatric patients with lumbar spondylolysis and biomechanical analysis using finite-element lumbar spine model. To evaluate the usefulness of the signal changes observed on MR images of the pedicle for the early diagnosis of spondylolysis, and to investigate the pathomechanism of the signal changes based on the stresses in pedicles, as predicted using finite-element analyses. Furthermore, to evaluate the usefulness of the signal change to predict the bony healing following conservative treatment. Since early-stage spondylolysis can achieve osseous healing conservatively, it is important to diagnose this disorder as early as possible. Presently, there is no well-established, noninvasive, and reliable diagnostic tool for the early diagnosis. Thirty-seven pediatric patients with spondylolysis were included. Sixty-eight defects were examined and their stages as revealed on CT scans were recorded. High signal changes (HSC) of the pedicles on axial T2-weighted MRI were compared with the CT-based stages of the defect. Among them, 16 patients, including 15 boys and 1 girl, were treated conservatively for at least a 3-month period. Bony healing of the fracture site was evaluated on CT, and the results were compared between two groups with or without HSC at the initial consultation. Using a three-dimensional nonlinear finite-element model of the L3-L5 segment, stress distributions in the pars and pedicle regions were analyzed in response to 400 N compression and 10.6 Nm moment. Based on CTs, 68 pars defects were classified as follows: 8 very early, 24 late-early, 16 progressive, and 20 terminal stages. All defects in very early and late-early stages (100%) showed HSC on T2-weighted MRI at the ipsilateral pedicle. Among 16 progressive stages, eight (50%) showed HSC, while no defects of the terminal stage (0%) were found to have HSC. In total, 29 pars defects were treated conservatively out of 16 patients. In 19 of the HSC positive defects, 15 (79%) showed bony healing after the conservative treatment, whereas none of the 10 HSC negative defects (0%) showed any healing. The results were statistically significant at P < 0.05 (chi). Stress results from the finite-element model indicated that pars interarticularis showed the highest value in all loading modes, and the pedicle showed the second highest. The correlation between the high stresses in the pedicle and the corresponding HSC suggest that signal changes in MRI could be used as an indicator for early diagnosis of spondylolysis. The HSC of the pedicle provided useful information to diagnose early stage spondylolysis. Furthermore, the HSC may be a good indicator as to whether a bony union will result from conservative treatment.

Magnetic resonance imaging in diagnosis and follow-up of impending spondylolysis in children and adolescents: early treatment may prevent pars defects

The lumbar spine was assessed by magnetic resonance imaging (MRI) in 14 children (mean age 12.4 years) with unspecific activity-related low back pain for more than 3 weeks presenting with normal plain radiographs. Impending spondylolysis was diagnosed when typical signal abnormalities were confined to the pars interarticularis without signs of thinning or fragmentation. After brace treatment for 3 months, follow-up MRI was performed 3 and 6 months after treatment. MRI signals returned to normal after 3 months in six patients and after 6 months in one patient. MRI showed promising results in detecting and monitoring the early onset of spondylolysis. Bracing and avoiding strenuous activities prevented the formation of pars defects in all our patients.

Cervical Spondylolysis in Children: Is It Posttraumatic?

Cervical spondylolysis is a rare defect of unknown etiology. Five cases of cervical spondylolysis as well as two cases of fractures of the pedicles of C2 in infants are presented. Comparison of the cases suggests that a fracture at birth or in infancy may be the cause of some cases of cervical spondylolysis.

Quantitative assessment with SPECT imaging of stress injuries of the pars interarticularis and response to bracing.

The evaluation and management of acute spondylolysis remains unclear in part because of outcome data that are primarily subjective. The aim of this study was to evaluate and monitor these patients objectively using quantitative single-photon emission computed tomography (SPECT). Thirty-four patients were so observed clinically between 1987 and 1996 and were studied with an initial and at least one follow-up SPECT scintigram. Initial radiographs and planar bone scans failed to demonstrate the pars lesion in 53 and 19% of the patients, respectively. The average SPECT ratio before brace treatment was 1.45. After treatment, this ratio significantly decreased to 1.27 (p = 0.03). A subset of patients remained symptomatic at follow-up. Their reduction in SPECT ratio averaged only 2.8% as compared with 13% for the remainder of the patients (p = 0.01). Patients diagnosed and braced in the early, more active stage of the condition (with greater intensity on SPECT) had more predictable symptom relief. An initial SPECT ratio of >1.5 was associated with complete symptom resolution after brace treatment. Patients treated with activity restriction only (>3 months) before bracing were more likely to have persistent symptoms and more modest improvement on SPECT (p = 0.01). These data, which use SPECT scintigraphy, support prompt treatment with brace immobilization for acute spondylolysis in children and adolescents.

Lumbar spondylolysis in children and adolescents

We investigated 185 adolescents under the age of 19 years with spondylolysis. All but five were active in sport. The pars defect was classified into early, progressive and terminal stages. Of the 346 pars defects in 185 patients, 39.6% were early, 29.5% progressive and 30.9% in the terminal stages. Conservative management produced healing in 73.0% of the early, 38.5% of the progressive and none of the terminal defects. These results suggest that spondylolysis is caused by repetitive microtrauma during growth and can be successfully treated conservatively if treatment is started in the early stage. There was elongation of the pars interarticularis as the pars defect progressed, and this is likely to be a consequence of the defect rather than a contributing cause.

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.

Defects of the pedicle and spondylolisthesis of the second cervical vertebra

The Journal of Bone and Joint Surgery. British volumeVol. 63-B, No. 4 ArticlesFree AccessDefects of the pedicle and spondylolisthesis of the second cervical vertebraDF Fardon, JW FieldingDF FardonSearch for more papers by this author, JW FieldingSearch for more papers by this authorPublished Online:1 Nov 1981https://doi.org/10.1302/0301-620X.63B4.7298677AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByA New Minimally Invasive Technique for Primary Unstable C2 Spondylolysis in an 8-Year-Old Child: A Case Report and Review of the LiteratureWorld Neurosurgery, Vol. 115Compression Myelopathy due to Proliferative Changes around C2 Pars Defects without InstabilityAsian Spine Journal, Vol. 10, No. 3Spondylolysis of C-2 in children 3 years of age or younger: clinical presentation, radiographic findings, management, and outcomes with a minimum 12-month follow-upJournal of Neurosurgery: Pediatrics, Vol. 13, No. 2Progressively Unstable C2 Spondylolysis Requiring Spinal Fusion: Case ReportNeurologia medico-chirurgica, Vol. 54, No. 9Anomalies22 June 2012Spondylolysis of C-2 in 2 athletically active individualsJournal of Neurosurgery: Spine, Vol. 13, No. 1Cervical spondylolysis in a child: a case with hypermobilityThe Spine Journal, Vol. 9, No. 1An abused five-month-old girl: Hangman’s fracture or congenital arch defect?The Journal of Emergency Medicine, Vol. 29, No. 1Second Cervical Vertebrae Pedicle Fractures Versus Synchondrosis in a ChildClinical Orthopaedics & Related Research, Vol. 413Congenital spondylolysis of the axis with associated myelopathyJournal of Neurosurgery: Spine, Vol. 98, No. 1Hangman??s Fracture Caused by Suspected Child Abuse. A Case ReportJournal of Pediatric Orthopaedics, Part B, Vol. 11, No. 4Hangmanʼs Fracture Caused by Suspected Child Abuse. A Case ReportJournal of Pediatric Orthopaedics B, Vol. 11, No. 4AnomaliesCervical Spondylolysis in Children: Is It Posttraumatic?Journal of Pediatric Orthopaedics, Vol. 20, No. 5Cervical Spondylolysis in Children: Is It Posttraumatic?Journal of Pediatric OrthopaedicsHelical Computed Tomography and Three-Dimensional Reconstruction of a Bipedicular Developmental Anomaly of the C2 VertebraSpine, Vol. 24, No. 10Persistent synchondrosis of the second cervical vertebra simulating a hangmanʼs fracture in a child. Report of a case.The Journal of Bone & Joint Surgery, Vol. 75, No. 8Computed tomography of congenital spondylolisthesis of the sixth cervical vertebraClinical Imaging, Vol. 15, No. 3Classification of StenosesPrimary spondylolysis of the axis vertebra (C2) in three children, including one with pyknodysostosisPediatric Radiology, Vol. 19, No. 8Malformations of the VertebraeCongenital absence of the C1 vertebral archThe American Journal of Emergency Medicine, Vol. 4, No. 4 Vol. 63-B, No. 4 Metrics Downloaded 95 times History Published online 1 November 1981 Published in print 1 November 1981 InformationCopyright © 1981, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Scoliosis and spondylolysis-spondylolisthesis.

Only little is known about the interrelation of scoliosis and spondylolysis-spondylolisthesis. Basically we may differentiate between scoliosis due to spondylolisthesis and spondylolisthesis probably due to scoliosis, with several subunits. Scoliosis due to spondylolisthesis is based on an asymmetrical forward shift of the fifth vertebra on the sacrum combined with one segment tilted. This results in a local instability with a compensatory lumbodorsal curve potentially becoming structural. The existence of a spondylolysis due to a dorsolumbar scoliosis is postulated on the basis of several observations, though no personal statistical data are available: In the presence of an idiopathic lumbodorsal scoliosis one encounters more frequently than expected an unilateral spondylolysis. On the other hand one may observe healing of the interarticular process of the laminae following the correction and fusion of a dorsolumbar scoliosis as occasionally seen with cast treatment of spondylolysis in children. Lumbar spondylolysis may create a progressive lumbar scoliosis even in early adulthood. The primary disease, may it be scoliosis or spondylolysis-spondylolisthesis, has to be treated according to its own rules conservatively or by operative fusion. The secondary disease requires treatment only if it becomes severe or painful.

Treatment of Spondylolisthesis and Spondylolysis in Children

There are 2 fairly common types of spondylolisthesis in children - dysplastic and isthmic. The dysplastic type is secondary to congenital defects at the lumbosacral joint. The isthmic is usually due to a fatigue fracture of the pars interarticularis but there is also an hereditary element in this type. Most children with spondylolisthesis never develop significant symptoms and even of those who do, the vast majority can be treated without surgery. If symptoms persist or if further olisthesis is occurring, a one-level spinal fusion done through a paraspinal approach is recommended. It is most important not to allow olisthesis to develop to the point that the child shows the cosmetically undesirable stigmata characteristic of the condition. Solid fusion can be obtained in every case and will stop further slip.

Incidence of Spondylolysis in Children and Young Peoples

The lumbar spines of 1055 children and young peoples under the age of 20 years, of which males were 601 and females 454, were examined by the anteroposterior, lateral and oblique X-ray.Out of the total, spondylolysis was found in 55 persons (5.2%), being 37 males (6.2%) and 18 females (3.0%). The youngest was a 7-year-old female.According to the age group, no spondylolysis was found in the group under the age of 4 years, and 10 (3.1%) in the group from 5 to 9 years, 25 (5.3%) in the group from 10 to 14 and 20 (10.8%) in the group from 15 to 20 years.

Spondylolysis in Children and Adolescents

Spondylolysis in Children and Adolescents