Low-Back Pain in Sports

Bilateral Spondylolysis of Lumbar Vertebra Secondary to Long Spinal Fusion for Idiopathic Scoliosis: A Case Report and Review of Literature

BACKGROUND

Lumbar spondylolysis is a common cause of low back pain in adolescents. A lot of adolescent idiopathic scoliosis with concomitant spondylolysis has been reported before, but only two cases with acquired spondylolysis following long fusion for scoliosis were reported. We described another similar rare case and discussed its causes and treatment options in this paper.

CASE PRESENTATION

A 17-year-old female underwent growing rod implantation, growing rod extension, and final long spinal fusion for idiopathic scoliosis. Then, she suffered from low back pain with a VAS of 1-2 points and gradually aggravated to a VAS of 7-8 points at 3.5 years after the final fusion. The X-ray images showed that there was L4-S1 instability. And the CT scan images showed new bilateral spondylolysis of L5.

CONCLUSIONS

These findings suggested that distal mechanical stress might cause spondylolysis of the distal vertebra following long fusion for scoliosis. Surgeons should keep instrumentation as short as possible and avoid choosing a low lumbar as LIV when they decide on the fusion levels.

Epidemiology of Spondylolisthesis: A Nationwide Study From 2001 to 2016 in the Italian Population

STUDY DESIGN

Epidemiological study.

OBJECTIVE

This study aimed to evaluate the annual incidence of spondylolisthesis requiring surgery in Italy and the epidemiological characteristics of the patients.

BACKGROUND

The health care system continues to incur considerable costs as a result of low-back pain. Segmental instability of the lumbar spine has attracted significant interest from researchers as a potential mechanism leading to mechanical low back pain.

MATERIALS AND METHODS

The Italian Ministry of Health's National Hospital Discharge Reports database in the 2001-2016 period was considered.

RESULTS

A total of 55,804 hospital admissions for spondylolisthesis were performed in Italy. The cumulative incidence was 6.8 interventions for every 100,000 Italian adult residents. The highest amount of procedures was recorded in the 65-69 years of age group. The overall patient's age was 56.8 ± 15.1 years. The 62.2% of patients were females. The average hospital stay length was 8.1 ± 7.3 days. On average, older patients require more days of hospital stay. Over the study period, it was observed a decreasing trend in the average number of days of hospital stay. The main primary diagnoses included were "acquired spondylolisthesis" [International Classification of Diseases (ICD) code: 738.4; 57.8%] and "spondylolisthesis" (ICD code: 756.12; 42.2%). By far, the main primary procedure performed was "lumbar and lumbosacral fusion of the anterior column, posterior technique" (ICD code: 81.08; 60.3%).

CONCLUSIONS

Spondylolisthesis is a problem in Italy and a leading cause requiring spine surgery. Females were the majority of patients requiring surgery for spondylolisthesis. However, for younger age groups, males showed superior or equal need for spine surgery. The socioeconomic impact of spondylolisthesis in Italy is relevant, affecting patients still in the working population. The increasing trend of spine surgery for spondylolisthesis in Italy may be attributable to the widespread diffusion of modern diagnostic and surgical technologies.

LEVEL OF EVIDENCE

Level II.

Mobilisation of the thoracic spine in the management of spondylolisthesis

INTRODUCTION

Segmental instability due to lumbar spondylolisthesis is a potential cause of chronic low back pain. Hypomobility of the spine results in compensatory segmental hypermobility of the segment above or below restricted segments. Therefore, the aim of the study is to determine the effects of mobilisation of the hypomobile upper thoracic spine along with conventional flexion exercises and stretching of short hip flexors on the degree of slippage and the functions of the persons with lumbar spondylolisthesis.

METHODOLOGY

All patients with spondylolisthesis were randomly assigned into two groups: Group I - Experimental group, treated with mobilisation of the thoracic spine along with the conventional physiotherapy and Group II - Conventional group, treated with conventional stretching, strengthening, and lumbar flexion exercise programme.

RESULTS

The experimental group treated with mobilisation of the thoracic spine shows a significant reduction in the percentage of vertebral slip from pre-treatment to post-treatment measurements.

CONCLUSION

Low back pain due to spondylolisthesis may be benefited by mobilisation of the thoracic spine along with stretching of short hip flexors, piriformis, lumbar flexion range of motion exercises, core strengthening exercises, etc.

Terapia manual no tratamento da espondilólise e espondilolistese: revisão de literatura

A espondilólise é um defeito na pars interarticularis da vértebra com descontinuidade óssea do segmento intervertebral; a progressão do defeito resulta em deslizamento de uma vértebra sobre a outra, chamado espondilolistese, o que pode provocar dor. O tratamento não-cirúrgico é a escolha inicial na maioria dos casos de espondilolistese, mas poucos estudos verificam a eficácia dos tratamentos conservadores. O objetivo deste estudo foi realizar uma revisão da literatura sobre esses tratamentos, sobretudo no que concerne à terapia manual, a fim de ajudar os terapeutas na prescrição de intervenções eficazes. Os resultados mostram que tanto a terapia manual como a fisioterapia convencional apresentam efeitos benéficos na redução da dor lombar e na melhora funcional do paciente. As terapias manuais envolvem manipulação da coluna vertebral e articulação sacroilíaca, músculo-energia e alongamento dos músculos afetados. Exercícios de estabilização lombopélvica, fortalecimento dos músculos posturais e alongamento dos isquiotibiais e psoas também foram considerados importantes. O paciente deve ser avaliado individualmente em seu quadro clínico e radiográfico para determinação do plano de tratamento. Dentre as opções conservadoras de tratamento encontradas, nenhuma se mostrou conclusivamente superior às outras e todas podem ser incluídas no tratamento sintomático de pacientes com espondilólise/listese.

Differential diagnosis of spondylolysis in a patient with chronic low back pain

STUDY DESIGN

Resident's case problem.

BACKGROUND

A 26-year-old male sought physical therapy services via direct access secondary to a flare-up of a chronic low back pain condition. The patient complained of recent onset of lumbosacral joint pain, including (1) constant right-sided deep-bruise sensation, (2) intermittent right-sided sharp stabbing pain, and (3) constant bilateral aching. The patient's past medical history included a hyperextension low back injury while playing football at age 17. Physical examination revealed (1) deep pain with palpation over the right lumbosacral joint region, (2) sharp right lumbosacral joint pain with 1 repetition of active trunk backward bending, and (3) a marked increase in pain and joint hypomobility with right unilateral joint assessment at the L4 and L5 spinal levels.

DIAGNOSIS

The examining therapist referred the patient for radiographic evaluation due to strong suspicions of a pars interarticularis bony defect. Lumbar plain films, oblique views, revealed an L5 bilateral pars defect, leading to a diagnosis of a longstanding bilateral L5 spondylolysis.

DISCUSSION

Patients with low back pain often seek physical therapy services. Identification of pathology requiring examination by other health care providers, leading to patient referral to other health care practitioners, is a potential important outcome of the therapist's examination. This resident's case problem illustrates the importance of a systematic examination scheme, including a thorough medical screening component that led to a patient referral for radiographic evaluation. The resultant diagnosis, although not representing serious pathology, did impact the therapist's patient plan of care.

A systematic review of physiotherapy for spondylolysis and spondylolisthesis

The purpose of this systematic review was to assess the evidence concerning the effectiveness of physiotherapy intervention in the treatment of low back pain related to spondylolysis and spondylolisthesis. A literature search of published and unpublished articles resulted in the retrieval of 71 potential studies on the subject area. Fifty-two of the 71 articles were studies, and these studies were reviewed using preset relevance criteria. Given the inclusion and exclusion criteria chosen for this systematic review, there were very few acceptable studies and only two studies met the relevance criteria for the critical appraisal. Both studies provide evidence to suggest that specific exercise interventions, alone or in combination with other treatments, have a positive effect on low-back pain due to spondylolysis and spondylolisthesis; however, the type of exercise used was different in the two studies. In this review, very few prospective studies were found that examined the efficacy of physiotherapy on the topic area; therefore, few conclusions can be made, and further research is warranted.

Epidemiology of juvenile low back pain: a review

Studies show that the cumulative prevalence of low back pain (LBP) in juveniles was close to 30%. The majority of the LBP was mild. Of those with LBP approximately 8% sought medical treatment. Chronic or recurrent LBP averaged 8.1% of the adolescent populations studied. The cumulative prevalence of LBP increased with age. One study showed a cumulative prevalence of LBP of over 70% by age 15. A potential link between the adolescent growth spurt and the increased prevalence of LBP was proposed. Asynchronous bone growth resulting in skeletal malalignment was proposed as a possible cause of LBP. Immaturity of the vertebral bony structures was thought to increase the risk of pars defects. Correlations between anthropometric measurements of height and weight were inconclusive. The role of decreased muscle flexibility in LBP was also inconclusive. Some researchers found a correlation between age, gender, height and LBP. Disc degeneration and spondylolytic symptoms were also noted as sources of LBP. However, not all cases of disc degeneration (DD) or spondylolysis were symptomatic of LBP. It was noted that the prevalence of DD was rare in adolescents. Disc protrusions were more common in LBP groups than in non-LBP groups, and females with LBP had more disc protrusions than males with LBP. Risk factors for spondylolysis and spondylolisthesis included genetics, the growth spurt, repetitive stresses and sports participation. Within competitive sports, age and training more than 15 hours/week correlated with the incidence of spondylolytic changes. Participation in sports as a risk factor for LBP was reported. A familial tendency for LBP was noted in one study in which the child had an increased incidence of reported LBP if one or both parents had a history of LBP.

Contraindications to Athletic Participation

In brief Physicians perform a delicate balancing act when they weigh a patient's medical condition against the safety of sports participation. This article, the second of a two-part series on contraindications to activity, examines the sensory, spinal, gastrointestinal, systemic, hematologic, and dermatologie conditions that warrant activity disqualification and provides guidelines about when it's safe to participate. Also discussed are activity considerations for patients who have lost a paired organ.

Contraindications to athletic participation: spinal, systemic, dermatologic, paired-organ, and other issues

Physicians perform a delicate balancing act when they weigh a patient's medical condition against the safety of sports participation. This article, the second of a two-part series on contraindications to activity, examines the sensory, spinal, gastrointestinal, systemic, hematologic, and dermatologic conditions that warrant activity disqualification and provides guidelines about when it's safe to participate. Also discussed are activity considerations for patients who have lost a paired organ.