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Asukai M, Banno T, Suzuki Y, Yamashita D, Murata H, Matsuyama Y. Spontaneous Bony Union of Bilateral Pseudoarthrotic Lumbar Spondylolysis without Surgery: A Case Report. Spine Surg Relat Res 2024; 8:221-224. [PMID: 38618221 PMCID: PMC11007248 DOI: 10.22603/ssrr.2023-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/31/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
- Mitsuru Asukai
- Department of Orthopaedic Surgery, Kikugawa General Hospital, Kikugawa, Japan
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshiji Suzuki
- Department of Orthopaedic Surgery, Kikugawa General Hospital, Kikugawa, Japan
| | - Daisuke Yamashita
- Department of Orthopaedic Surgery, Kikugawa General Hospital, Kikugawa, Japan
| | - Hideyuki Murata
- Department of Orthopaedic Surgery, Kikugawa General Hospital, Kikugawa, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Peng Z, Jia Y, Li J, Wang G. Diagnostic performance of SPECT in lumbar spondylolysis: a systematic review and meta-analysis. Clin Radiol 2024; 79:e137-e146. [PMID: 37919216 DOI: 10.1016/j.crad.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/16/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
AIM To evaluate the diagnostic value and clinical applicability of single-photon-emission computed tomography (SPECT) for lumbar spondylolysis using meta-analysis. MATERIALS AND METHODS Stata 12.0, was used to test the heterogeneity, and the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and other effect sizes were collected to generate the summary receiver operating characteristic (SROC) curve for comprehensive evaluation. Meta-regression analysis was used to explore the source of heterogeneity, and subgroup analysis was performed. Funnel plots, Fagan's line diagrams, and likelihood ratio dot plots were drawn to evaluate publication bias and clinical applicability. RESULTS Eight studies involving 785 patients were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, odds ratio, and area under the SROC curve of SPECT for the diagnosis of lumbar spondylolysis were 0.85 (95% confidence interval [CI]: 0.70 0.93), 0.92 (95% CI: 0.60 0.99), 11.01 (95% CI: 1.61 75.18), 0.17 (95% CI: 0.08 0.35), 0.92 (95% CI: 0.90 0.94). Meta-regression analysis showed that the sources of heterogeneity were region and age. Subgroup analysis showed that the specificity of the child and adolescent subgroup was significantly higher than that of the middle-aged and elderly subgroups. Deek's funnel plots showed no significant publication bias. The pooled effect of the likelihood ratio dot plot for diagnosis is in the upper-right quadrant. CONCLUSION As a diagnostic tool for spondylolysis, SPECT has a high degree of specificity, moderate sensitivity, and relatively high diagnostic effectiveness. It can be used as an auxiliary sign in the diagnosis and treatment of lumbar spondylolysis.
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Affiliation(s)
- Z Peng
- Department of Spinal Surgery, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, 518101, China.
| | - Y Jia
- Department of Spinal Surgery, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, 518101, China
| | - J Li
- Department of Spinal Surgery, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, 518101, China
| | - G Wang
- Department of Spinal Surgery, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, 518101, China
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Takei S, Torii S, Taketomi S, Iwanuma S, Tojima M, Otomo M, Iizuka S, Tanaka S. Is Increased Kicking Leg Iliopsoas Muscle Tightness a Predictive Factor for Developing Spondylolysis in Adolescent Male Soccer Players? Clin J Sport Med 2022; 32:e165-e171. [PMID: 33844489 DOI: 10.1097/jsm.0000000000000920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify predictive risk factors of lumbar stress (LS) fracture developing from an asymptomatic stress reaction of the pedicle among adolescent male soccer players. DESIGN Prospective cohort study. SETTING Amateur Japanese adolescent male soccer team. PARTICIPANTS Japanese adolescent male soccer players (n = 195) aged 12 to 13 years. ASSESSMENT OF RISK FACTORS INDEPENDENT VARIABLES Height, body weight, body mass index, muscle tightness of both lower extremities (iliopsoas, hamstrings, and quadriceps), lumbar bone mineral content, developmental age, and lumbar lordosis angle were measured as baseline measurements. MAIN OUTCOME MEASURES DEPENDENT VARIABLE Players who were diagnosed with an asymptomatic stress reaction of the lumbar spine pedicle at baseline were followed; extension-based lumbar pain was defined 1 year after the baseline. The players were assigned to the LS fracture or control (CON) group at follow-up. RESULTS At baseline, 40 boys were diagnosed with an asymptomatic stress reaction of the lumbar spine pedicle. The difference in muscle tightness between the kicking leg and supporting leg was significantly different (P = 0.012) between the LS (n = 16) and CON (n = 22) groups. Increase in iliopsoas muscle tightness in the kicking leg was a predictive risk factor of developing extension-based lumbar pain after adjusting for developmental age and body mass index (odds ratio, 1.54; 95% confidence interval, 1.05-2.27). CONCLUSIONS Development of extension-based lumbar pain from an asymptomatic stress reaction of the pedicle among adolescent male soccer players was associated with increased iliopsoas muscle tightness of the kicking leg relative to that of the supporting leg.
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Affiliation(s)
- Seira Takei
- Orthopaedic Surgery, Sensory and Motor System Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Shuji Taketomi
- Orthopaedic Surgery, Sensory and Motor System Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Soichiro Iwanuma
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
- Faculty of Education and Human Sciences, Department of School Education, Teikyo University of Science, Tokyo, Japan
| | - Michio Tojima
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
- School of Human and Social Sciences, Tokyo International University, Saitama, Japan ; and
| | - Mana Otomo
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
- Japan Institute of Sport Sciences, Tokyo, Japan
| | - Satoshi Iizuka
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
- Japan Institute of Sport Sciences, Tokyo, Japan
| | - Sakae Tanaka
- Orthopaedic Surgery, Sensory and Motor System Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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The Management of Acute Lumbar Stress Reactions of the Pedicle and Pars in Professional Athletes Playing Collision Sports. Clin Spine Surg 2021; 34:247-259. [PMID: 32991362 DOI: 10.1097/bsd.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/19/2020] [Indexed: 11/26/2022]
Abstract
Acute stress reactions in the lumbar spine most commonly occur in athletes at the pars interarticularis followed by the pedicle. These reactions occur as a result of repetitive microtrauma from supraphysiological loads applied to the lumbar spine. Characteristic motions such as trunk extension and twisting are also thought to play a role and may be sport-specific. Other risk factors include increased lumbar lordosis, hamstring and thoracolumbar fascia tightness, and abdominal weakness. On physical examination, pain is typically reproduced with lumbar hyperextension. Currently, magnetic resonance imaging or nuclear imaging remain the most sensitive imaging modalities for identifying acute lesions. In the elite athlete, management of these conditions can be challenging, particularly in those playing collision sports such as American football, hockey, or rugby. Nonoperative treatment is the treatment of choice with rehabilitation programs focused on pain-free positioning and progressive strengthening. Operative treatment is rare, but may be warranted for patients symptomatic for >12 months. Specialized diagnosis protocols as well as treatment and return to play guidelines from 4 physicians treating elite athletes playing collision sports are presented and reviewed.
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Abstract
Repetitive stress on the lumbosacral spine during sporting activity places the athletic patient at risk of developing symptomatic pars defect. Clinical history, physical examination, and diagnostic imaging are important to distinguish spondylolysis from other causes of lower back pain. Early pars stress reaction can be identified with advanced imaging, before the development of cortical fracture or vertebral slip progression to spondylolisthesis. Conservative management is first-line for low-grade injury with surgical intervention indicated for refractory symptoms, severe spondylolisthesis, or considerable neurologic deficit. Prompt diagnosis and management of spondylolysis leads to good outcomes and return to competition for most athletes.
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Affiliation(s)
- Christopher C Chung
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908, USA
| | - Adam L Shimer
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908, USA.
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Increased sagittal diameter of the vertebral arch aids in diagnosis of lumbar spondylolysis. Skeletal Radiol 2021; 50:1125-1130. [PMID: 33112978 PMCID: PMC8035112 DOI: 10.1007/s00256-020-03658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify a diagnostic indicator of lumbar spondylolysis visible in plain X-ray films. METHODS One hundred and seventy-two patients with low back pain who received X-ray and computerized tomography (CT) examinations were identified and studied. They were divided into three groups: the spondylosis without spondylolisthesis (SWS) group, comprising 67 patients with bilateral pars interarticularis defects at L5 and without spondylolisthesis, the isthmic spondylolisthesis (IS) group, comprising 74 patients with L5/S1 spondylolisthesis and bilateral L5 pars interarticularis defects, and the control group, comprising 31 patients with low back pain but without spondylolysis. The sagittal diameters of the vertebral arch (SDVAs) of L4 and L5 were measured in lateral X-ray image, and the differences in SDVA between L4 and L5 (DSL4-5) in each case were calculated and analyzed. RESULTS There were no significant differences in demographic characteristics among the three groups. In the SWS and IS groups, the SDVA of L5 was significantly longer than the SDVA of L4 (p < 0.001), whereas no significant difference found in the control group (p > 0.05). DSL4-5, in which the SDVA of L4 was subtracted from the SDVA of L5, significantly differed among the three groups (p < 0.001), and the normal threshold was provisionally determined to be 1.55 mm. CONCLUSIONS In bilateral L5 spondylolysis, the SDVA of L5 is wider than the SDVA of L4, and this difference is greater in isthmic spondylolisthesis. This sign in lateral X-rays may provide a simple and convenient aid for the diagnosis of spondylolysis.
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The Joe-Lin Operative Classification System for Pediatric Lumbosacral Spondylolysis and Spondylolisthesis. World Neurosurg 2020; 142:e18-e31. [PMID: 32434018 DOI: 10.1016/j.wneu.2020.05.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To propose and validate a novel and comprehensive classification of lumbosacral spondylolysis and spondylolisthesis in the pediatric population according to surgical managements. METHODS Cases of pediatric lumbosacral (L5/S1 level) spondylolysis and spondylolisthesis were reviewed. Lumbar Japanese Orthopedics Association score, health-related quality of life, spondylolisthesis, lumbosacral disc degeneration, and dysplastic features were included for evaluation of outcomes after surgery. We also conducted a reliability study to assess the classification. RESULTS A classification containing 4 types and a tentative treatment algorithm were proposed: type 1, direct pars repair without segmented fusion, for which the pedicle screw-U rod system is suitable; type 2, simple L5-S1 fusion; type 3, simple L4-S1 fusion; and type 4, simple L5-S2 fusion. All types of spondylolisthesis were suggested to achieve complete reduction and decompression. A total of 162 patients were included and we also reviewed the outcomes of patients in each type. All patients achieved satisfied outcomes. The reliability study showed that the average interobserver agreement was 89.5% (range, 85.2%-92.6%), with κ value of 0.862 (range, 0.802-0.901). Intraobserver agreement ranged from 88.9% to 92.6%, with an average κ value of 0.868 (range, 0.835-0.901). CONCLUSIONS In our study, we proposed and validated a novel comprehensive classification of pediatric lumbosacral spondylolysis and spondylolisthesis. The pedicle screw-U rod system provided more benefits in the treatment of simple lumbosacral spondylolysis, and fusion from L5 to S2 combined with S2 screw would also benefit patients with high-degree spondylolisthesis.
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Massel DH, Mayo BC, Long WW, Modi KD, Lopez GD, Shifflett GD, Basques BA, Louie PK, Bohl DD, Hijji FY, Narain AS, Singh K. Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Grade I Versus Grade II Isthmic Spondylolisthesis. Int J Spine Surg 2020; 14:108-114. [PMID: 32355614 DOI: 10.14444/7016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is often used to treat low-grade isthmic spondylolisthesis (IS). No studies have compared surgical outcomes for grade I and II IS following MIS-TLIF. Therefore, the objective of the current study was to compare outcomes between patients with grade I and II IS following MIS-TLIF. Methods A retrospective cohort analysis was performed on a prospectively maintained database of patients who underwent a primary 1-level MIS-TLIF for treatment of IS between 2007 and 2015. Grade I patients underwent a unilateral tubular approach with a single interbody cage and bilateral pedicle screw instrumentation. Grade II patients underwent a bilateral tubular approach with bilateral interbody cage and pedicle screw placement. Baseline patient demographics and characteristics were compared using Student t test and χ2 analysis. Differences in peri- and postoperative outcomes were assessed using Poisson regression with robust error variance or linear regression adjusted for perioperative variables. Results A total of 58 patients with IS underwent MIS-TLIF; 21 (36.2%) were grade I and 37 (63.8%) were grade II. The grade I cohort was younger (42.2 versus 50.6 years, P = .029); no other differences in preoperative variables were observed. No significant differences in operative time, estimated blood loss, length of hospital stay, postoperative visual analogue scale scores, or complication and revision rates were demonstrated between cohorts. Arthrodesis rate was lower in the grade I cohort, though not statistically significant. Conclusions Despite the grade I cohort being younger with less-severe diagnoses, the grade II cohort experienced similar outcomes. This finding may be due to the grade II cohort receiving bilateral cages, potentially providing a better fusion environment. Clinical Relevance These results suggest that MIS-TLIF provides sufficient stabilization and fusion for treatment of grade II IS despite increased vertebral body displacement. In addition, MIS-TLIF with bilateral approach and interbody cage placement should be examined for treatment of high-grade IS cases.
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Affiliation(s)
- Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Benjamin C Mayo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - William W Long
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Krishna D Modi
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Gregory D Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Grant D Shifflett
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Fady Y Hijji
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Ankur S Narain
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
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Plomp KA, Dobney K, Collard M. Spondylolysis and spinal adaptations for bipedalism: The overshoot hypothesis. EVOLUTION MEDICINE AND PUBLIC HEALTH 2020; 2020:35-44. [PMID: 32153781 PMCID: PMC7053264 DOI: 10.1093/emph/eoaa003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/08/2020] [Indexed: 12/19/2022]
Abstract
Background and objectives The 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. Methodology We 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. Results We 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. Conclusions Our 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.
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Affiliation(s)
- Kimberly A Plomp
- Department of Archaeology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.,Department of Archaeology, Classics and Egyptology, University of Liverpool, 14 Abercromby Square, Liverpool L69 7WZ, UK
| | - Keith Dobney
- Department of Archaeology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.,Department of Archaeology, Classics and Egyptology, University of Liverpool, 14 Abercromby Square, Liverpool L69 7WZ, UK.,Department of Archaeology, University of Aberdeen, St Mary's, Elphinstone Road, Aberdeen AB24 3UF, UK
| | - Mark Collard
- Department of Archaeology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
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Prevalence of Spondylolysis in Symptomatic Adolescent Athletes: An Assessment of Sport Risk in Nonelite Athletes. Clin J Sport Med 2019; 29:421-425. [PMID: 31460956 DOI: 10.1097/jsm.0000000000000546] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the risk of spondylolysis by sport in nonelite adolescent athletes with low back pain (LBP). DESIGN Retrospective case series. SETTING Hospital-based sports medicine clinic. PATIENTS The medical charts of 1025 adolescent athletes with LBP (age 15 ± 1.8 years) were examined; 308 (30%) were diagnosed with a spondylolysis. ASSESSMENT OF RISK Risk of spondylolysis was assessed in 11 sports for males and 14 sports for females. MAIN OUTCOME MEASURE Relative risk of diagnosis of spondylolysis injury. RESULTS The risk of spondylolysis differed by sex with baseball (54%), soccer (48%), and hockey (44%) having the highest prevalence in males and gymnastics (34%), marching band (31%), and softball (30%) for female athletes. Baseball was the only sport to demonstrate a significant increased risk of spondylolysis. CONCLUSIONS The sports with the greatest risk of spondylolysis in adolescent athletes in this study were not consistent with published literature. Clinicians should be cautious generalizing high-risk sports to their practice, as geographic region and level of the athlete may significantly influence the incidence of spondylolysis in the population they are treating.
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Dhouib A, Tabard-Fougere A, Hanquinet S, Dayer R. Diagnostic accuracy of MR imaging for direct visualization of lumbar pars defect in children and young adults: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:1058-1066. [DOI: 10.1007/s00586-017-5305-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/13/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
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Abstract
STUDY DESIGN A systematic review. OBJECTIVE The aim of this study was to provide an evidence-based recommendation for when and how to employ imaging studies when diagnosing back pain thought to be caused by spondylolysis in pediatric patients. SUMMARY OF BACKGROUND DATA Spondylolysis is a common structural cause of back pain in pediatric patients. The radiologic methods and algorithms used to diagnose spondylolysis are inconsistent among practitioners. METHODS A literature review was performed in PubMed and Cochrane databases using the search terms "spondylolysis," "pediatric," "adolescent," "juvenile," "young," "lumbar," "MRI," "bone scan," "CT," and "SPECT." After inclusion criteria were applied, 13 articles pertaining to diagnostic imaging of pediatric spondylolysis were analyzed. RESULTS Ten papers included sensitivity calculations for comparing imaging performance. The average sensitivity of magnetic resonance imaging (MRI) with computed tomography (CT) as the standard of reference was 81.4%. When compared with single-photon emission CT (SPECT), the average sensitivity of CT was 85% and the sensitivity of MRI was 80%. Thirteen studies made a recommendation as to how best to perform diagnostic imaging of patients with clinically suspected spondylolysis. When compared with two-view plain films, bone scans had seven to nine times the effective radiation dose, while four-view plain films and CT were approximately double. Of the diagnostic methods examined, MRI was the most expensive followed by CT, bone scan, four-view plain films, and two-view plain films. CONCLUSION Due to their efficacy, low cost, and low radiation exposure, we find two-view plain films to be the best initial study. With unusual presentations or refractory courses, practitioners should pursue advanced imaging. MRI should be used in early diagnosis and CT in more persistent courses. However, the lack of rigorous studies makes it difficult to formulate concrete recommendations. LEVEL OF EVIDENCE 3.
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Low-intensity pulsed ultrasound is effective for progressive-stage lumbar spondylolysis with MRI high-signal change. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:3122-3128. [PMID: 28391380 DOI: 10.1007/s00586-017-5081-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/16/2017] [Accepted: 03/28/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE This study aimed to investigate the treatment effects of low-intensity pulsed ultrasound (LIPUS) on progressive-stage spondylolysis. Spondylolysis is a stress fracture of the pars interarticularis. Based on the results of computed tomography, spondylolysis was classified into three categories: early, progressive, and terminal. Bone healing was prolonged or not obtained in progressive-stage spondylolysis. The progression of spondylolysis to nonunion has been associated with an increased incidence of spondylolisthesis. To prevent these clinical conditions, achieving bony healing of the spondylolysis site should be the goal of treatment. METHODS 15 consecutive pediatric patients with progressive-stage spondylolysis (defects) with MRI high-signal change were analyzed. Nine patients were treated conservative treatment including avoidance of any sport activity and the use of a brace during treatment (conventional). Six patients were treated using LIPUS everyday during treatment in addition to conservative treatment. Approximately every 1.5 months, bone healing was evaluated via CT. Cases that retained defects after 4.5 months were defined as nonunion. RESULTS Two patients dropped out during the study period. A total of 13 patients (mean 14.6 ± 2.5 years) from the database met with 19 interarticularis defects. The bone union rate in LIPUS group was significantly higher than that in conventional group (66.7 vs. 10.0%, p = 0.020). The treatment period to bone union was 3.8 months and 2.7 ± 0.3 months in conventional and LIPUS groups. CONCLUSIONS This study revealed that LIPUS treatment might be effective for bone union in patients with progressive-stage spondylolysis with MRI high-signal change. LEVEL OF EVIDENCE 4.
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Lara-Almunia M, Gomez-Moreta JA, Hernandez-Vicente J. Posterior lumbar interbody fusion with instrumented posterolateral fusion in adult spondylolisthesis: description and association of clinico-surgical variables with prognosis in a series of 36 cases. Int J Spine Surg 2015. [PMID: 26196029 DOI: 10.14444/2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We present our experience in the treatment of patients with isthmic or degenerative spondylolisthesis, by means of a posterior lumbar interbody fusion (PLIF) and instrumented posterolateral fusion (IPLF), and we compare them with those published in the literature. We analyse whether there exists any statistical association between the clinical characteristics of the patient, radiological characteristics of the disease and our surgical technique, with the complications and the clinical-radiological prognosis of the cases. METHOD We designed a prospective study. A total of 36 cases were operated. The patients included were 14 men and 22 women, with an average age of 57.17±27.32 years. Our technique consists of PLIF+IPLF, using local bone for the fusion. The clinical results were evaluated with the Visual Analogical Scale (VAS) and the Kirkaldy-Willis criteria. The radiological evaluation followed the Bratingan (PLIF) and Lenke (IPLF) methodology. A total of 42 variables were statistically analysed by means of SPSS18. We used the Paired Student's T-test, logistic regression and Pearson's Chi-square-test. RESULTS The spondylolisthesis was isthmic in 15 cases and degenerative in 21 cases. The postoperative evaluations had excellent or good results in 94.5% (n = 34), with a statistically significant improvement in the back pain and sciatica (p < 0.01). The rate of circumferential fusion reached was approximately 92%. We had 13.88% of transitory morbility and 0% of mortality associated with our technique. A greater age, degree of listhesis or length of illness before the intervention, weakly correlated with worse clinical results (p< -0.2). In our series, the logistical regression showed that the clinical characteristics of the patient, radiological characteristics of the lesion and our surgical technique were not associated with greater postoperative complications. CONCLUSION Although a higher level of training is necessary, we believe that the described technique is a very effective decision in cases of spondylolisthesis, isthmic or degenerative, refractory to conservative treatment, for the obtaining the best clinical results and rates of fusion, with similar risks to those of the other published techniques. Our statistical analysis could contribute to improve outcomes after surgery.
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Affiliation(s)
- Monica Lara-Almunia
- Department of Neurosurgery, Son Espases University Hospital, Mallorca, Spain
| | - Juan A Gomez-Moreta
- Department of Neurosurgery, University Hospital of Salamanca, Salamanca, Spain
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Goda Y, Sakai T, Sakamaki T, Takata Y, Higashino K, Sairyo K. Analysis of MRI signal changes in the adjacent pedicle of adolescent patients with fresh lumbar spondylolysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1892-5. [PMID: 24682354 DOI: 10.1007/s00586-013-3109-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study is to investigate a discrepancy between MRI and computed tomography (CT) findings in the spinal level distribution of spondylolysis. Recent advances in MRI have led to the early diagnosis of spondylolysis. Therefore, bony healing can be expected before the condition has a chance to worsen. In this study, we used MRI to examine the changes in spinal level signals in the pedicles adjacent to the pars interarticularis in adolescents with fresh lumbar spondylolysis. We then compared spinal level distribution of spondylolysis with that of previous results obtained by multidetector CT. METHODS The study included 98 adolescent patients (31 women and 67 men; mean age, 13.6 years; age range, 9-18 years) with fresh lumbar spondylolysis who showed MRI signal changes in the adjacent pedicle. An MRI signal change was defined as a high signal change on fat-suppressed imaging. RESULTS MRI signal changes were detected in 150 adjacent pedicles of 101 vertebrae. Of these vertebrae, MRI signal changes in only 67 (66.3%) corresponded to L5, while changes in 34 (33.7%) corresponded to L3 or L4. In our follow-up study, the bone-healing rate with no vertebral defect was 100% at L3, 97.1% at L4, and 84.4% at L5. In addition, 11 of 34 (32.4%) vertebrae with signal changes at L3 or L4 occurred with L5 terminal-stage spondylolysis (no MRI signal change). CONCLUSION MRI revealed a higher prevalence of L3 or L4 spondylolysis than observed with CT.
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Affiliation(s)
- Yuichiro Goda
- Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan,
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Garet M, Reiman MP, Mathers J, Sylvain J. Nonoperative treatment in lumbar spondylolysis and spondylolisthesis: a systematic review. Sports Health 2014; 5:225-32. [PMID: 24427393 PMCID: PMC3658408 DOI: 10.1177/1941738113480936] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Context: Both spondylolysis and spondylolisthesis can be diagnosed across the life span of sports-participating individuals. Determining which treatments are effective for these conditions is imperative to the rehabilitation professional. Data Sources: A computer-assisted literature search was completed in MEDLINE, CINAHL, and EMBASE databases (1966-April 2012) utilizing keywords related to nonoperative treatment of spondylolysis and/or spondylolisthesis. Reference lists were also searched to find all relevant articles that fit our inclusion criteria: English language, human, lumbar pain with diagnosed spondylolysis and/or spondylolisthesis, inclusion of at least 1 nonoperative treatment method, and use of a comparative study design. Data Extraction: Data were independently extracted from the selected studies by 2 authors and cross-referenced. Any disagreement on relevant data was discussed and resolved by a third author. Results: Ten studies meeting the criteria were rated for quality using the GRADE scale. Four studies found surgical intervention more successful than nonoperative treatment for treating pain and functional limitation. One study found no difference between surgery and nonoperative treatment with regard to future low back pain. Improvement was found in bracing, bracing and exercises emphasizing lumbar extension, range of motion and strengthening exercises focusing on lumbar flexion, and strengthening specific abdominal and lumbar muscles. Conclusion: No consensus can be reached on the role of nonoperative versus surgical care because of limited investigation and heterogeneity of studies reported. Studies of nonoperative care options suffered from lack of blinding assessors and control groups and decreased patient compliance with exercise programs.
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Affiliation(s)
- Matthew Garet
- Duke University Medical Center, Durham, North Carolina
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Kobayashi A, Kobayashi T, Kato K, Higuchi H, Takagishi K. Diagnosis of radiographically occult lumbar spondylolysis in young athletes by magnetic resonance imaging. Am J Sports Med 2013; 41:169-76. [PMID: 23136176 DOI: 10.1177/0363546512464946] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The early stages of spondylolysis are extremely difficult to diagnose on plain radiography. Although several studies have examined changes in active spondylolysis on magnetic resonance imaging (MRI), no studies to date have determined the onset frequency of active spondylolysis detectable on MRI but occult on plain radiography. Moreover, the clinical features of active spondylolysis described in the literature do not facilitate the differentiation of this condition from other causes of low back pain. PURPOSE This study aimed to evaluate the usefulness of MRI in diagnosing active spondylolysis early and in determining the prevalence of active spondylolysis in cases where findings were not detected on plain radiography. In addition, specific clinical features to aid in the early detection of active spondylolysis were evaluated. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients were 200 consecutive young athletes (144 boys and 56 girls; mean age, 14.1 ± 1.5 y) with low back pain. All patients were examined by plain radiography (188 with negative findings and 12 with unclear findings of spondylolysis) and MRI. Computed tomography (CT) was performed only for patients with high intensity changes of the pedicle observed on MRI. The presence or absence of low back pain was examined during lumbar spine extension and flexion. The Kemp test on the right and left sides and percussion of the vertebral spinous process were also performed. RESULTS Ninety-seven (48.5%) patients showed evidence of active spondylolysis on MRI, findings that had been missed by plain radiography. These pars defects were organized into the following categories based on CT findings: nonlysis stage, 52; very early stage, 37; late early stage, 22; progressive stage, 10; and terminal stage, 0. No significant physical examination factors were identified that could assist in the early detection of active spondylolysis. CONCLUSION The MRI results suggest a high rate of active spondylolysis in young athletes with low back pain who test negative for spondylolysis on plain radiography. Magnetic resonance imaging appears to be useful in the early diagnosis of active spondylolysis, especially as we found no significant physical examination factors that could assist in early detection.
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Crostelli M, Mazza O. AIS and spondylolisthesis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22 Suppl 2:S172-84. [PMID: 22569830 DOI: 10.1007/s00586-012-2326-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 04/15/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The association of scoliosis and spondylolisthesis is well documented in literature; the nature and modalities of the relationship of the two pathologies are variable and not always clear. Also, etiologic particulars of scoliosis associated with spondylolisthesis are not well defined, even in cases where scoliosis is called idiopathic. In this paper, we review previous literature and discuss the different aspects of the mutual relationship of scoliosis and spondylolisthesis in the adolescent age. MATERIALS AND METHODS It is a common notion that the highest occurrence of scoliosis associated with spondylolisthesis is at the lumbar level, both in adolescent and in adult patients. It is probable that the scoliosis that is more heavily determined by the presence of spondylolisthesis is at the lumbar level and presents curve angle lower than 15° Cobb and mild rotation. The scoliosis with curve value over 15° Cobb that is present at the lumbar level in association with spondylolisthesis probably is not prominently due to spondylolisthesis: in these cases, spondylolisthesis is probably only partially responsible for scoliosis progression with a spasm mechanism and/or due to rotation of slipping "olisthetic" vertebra. DISCUSSION We think that the two pathologies should be treated separately, as stated by many other authors, but we would highlight the concept that, whatever be the scoliosis curve origin, spasm, olisthetic or mixed together, this origin has no influence on treatment. The curves should be considered, for all practical effects, as so-called idiopathic scoliosis. We think that generally patient care should be addressed to treat only spondylolisthesis or only scoliosis, if it is necessary on the basis of clinical findings and therapeutic indications of the isolated pathologies, completely separating the two diseases treatments. CONCLUSIONS Scoliosis should be considered as an independent disease; only in the case of scoliosis curve progression over time, associated scoliosis must be treated, according to therapeutic principles of the care of any so-called idiopathic scoliosis of similar magnitude, and a similar approach must be applied in the case of spondylolisthesis progression or painful spondylolisthesis.
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Affiliation(s)
- Marco Crostelli
- Spine Disease Unit, Bambino Gesù Pediatric Hospital, Via della Torre di Palidoro 1, 00100 Palidoro-Rome, Italy.
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Abstract
BACKGROUND Spondylolysis and spondylolisthesis are common abnormalities of the lumbar spine. The incidence of these diagnoses is recognized in the healthy population. However, their incidence in osteogenesis imperfecta (OI) patients is less well defined. METHODS This is a retrospective radiographic review of patients treated in the OI clinic from a single institution. Lateral radiographs were reviewed on all available patients to assess the incidence of spondylolysis and spondylolisthesis in this patient population. The morphology of the pedicle and pars interarticularis was also evaluated to identify any abnormalities or dysplasia of these structures. RESULTS One hundred ten of the 139 patients treated in the OI clinic met the inclusion criteria for this study. Of these patients, 79% (87 of 110) were ambulatory. The overall incidence of spondylolysis in this pediatric OI population was found to be 8.2% (9 of 110) at an average age of 7.5 years. The incidence of spondylolisthesis was 10.9% (12 of 110) at an average age of 6.5 years with 75% (3 of 12) being isthmic type and 25% (3 of 12) dysplastic. The combined incidence of spondylolysis and spondylolisthesis was 19.2%. Incidentally, the pedicle length was noted to be elongated in 40.0% (44 of 110) of this OI population. CONCLUSIONS This study found that the incidence of spondylolysis in a group of children with OI was much higher than in the normal pediatric population, which has been reported to be 2.6% to 4.0%. This incidence was also found to be higher than previously reported incidence of spondylolysis in OI patients (5.3%). The incidence of spondylolisthesis was also found to be much higher than that of the normal pediatric population (4.2%). It is important to recognize this higher incidence of these abnormalities and to anticipate future associated symptoms and potential worsening listhesis that can clinically affect the lifestyles of these children and potentially require surgical treatment. The clinical significance of these findings will necessitate long-term follow-up.
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Spondylolysis and spondylolisthesis: a narrative review of etiology, diagnosis, and conservative management. J Chiropr Med 2011; 4:206-17. [PMID: 19674664 DOI: 10.1016/s0899-3467(07)60153-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To review current literature regarding the etiology, diagnosis, and conservative treatment of spondylolysis and spondylolytic spondylolisthesis. METHODS The PubMed database was searched for articles on spondylolysis and/or spondylolisthesis and their incidence, diagnosis, imaging, treatment, and prognosis. The bibliographies of articles determined to be relevant were also reviewed. RESULTS A PubMed search of spondylolysis or spondylolis-thesis yielded over 800 citations. Sixty-eight articles were selected based on an opinion of perceived relevance to the subjects of spondylolysis and spondylolisthesis. CONCLUSIONS Spondylolysis affects approximately 6% of the population. The lesion likely represents a stress fracture and the typical age of onset is early childhood and adolescence. Most individuals are asymptomatic. Adolescents with low back pain may have an impending or new pars defect. A high index of suspicion for a new pars defect should prompt utilization of physiologic imaging to determine the likelihood of pars union in young patients. Restrictive bracing may lead to healing of the fracture and cessation of pain. Spondylolisthesis is a common complication of spondylolysis. Spondylolisthesis progression is typically small and most likely in young individuals. Significant progression in adults is rare. The finding of spondylolysis and spondylolisthesis in an adult patient is usually incidental and not likely to be a direct source of pain unless there is concurrent instability.
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Haidar R, Saad S, Khoury NJ, Musharrafieh U. Practical approach to the child presenting with back pain. Eur J Pediatr 2011; 170:149-56. [PMID: 20495823 DOI: 10.1007/s00431-010-1220-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 05/05/2010] [Indexed: 03/03/2023]
Abstract
Back pain may be the presenting symptom of many children attending to pediatric health care settings. As such, awareness to the common etiologies of back pain in this subgroup of patients remains essential as it guides appropriate diagnosis. Although several clues may be derived from the child's history and physical examination, imaging techniques may be required to confirm the underlying diagnosis. This review summarizes the most commonly encountered causes of back pain in children and highlights diagnostic approaches that will ensure early diagnosis and intervention for a more favorable outcome.
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Affiliation(s)
- Rachid Haidar
- Department of Surgery, American University of Beirut Medical Center, Riad El Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon.
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Abstract
AIM This article explores lumbar disc herniation in young children through focusing on matters relevant to patient presentation, physical examination, differential diagnosis, imaging and treatment. METHODS Major databases were searched for studies that addressed lumbar disc herniation in young children. RESULTS Diagnosis of lumbar disc herniation in young children is usually delayed because of the rarity and lack of experience with this entity and the difficulty in extracting a reliable medical history. Nevertheless, lumbar disc herniation should be considered in the differential diagnosis of any young child presenting with a chief complaint of back pain and/or radiculopathy, especially in the setting of recent trauma. This should be coupled with a directed physical examination to elicit signs and narrow the differential diagnosis. Imaging studies, mainly magnetic resonance imaging, will help establish a diagnosis; yet radiographs are still required to exclude other spinal lesions. The initial management of lumbar disc herniation in children is the same as that in adults and consists of conservative treatment unless lumbar disc herniation affects the patient's motor and neurological functions in which case, early surgical treatment must be undertaken. Although the latter remains more difficult, current experience suggests a favourable outcome. CONCLUSION Awareness of lumbar disc herniation will help the paediatrician extract a relevant medical history, perform a directed physical examination, and order appropriate imaging studies. This will aid in initiating early intervention, be it conservative or operative, and achieving a favourable outcome.
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Affiliation(s)
- R Haidar
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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24
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Biswas D, Grauer JN, Whang PG. Direct Repair of the Pars Interarticularis in the Child and Adolescent. Tech Orthop 2009. [DOI: 10.1097/bto.0b013e3181b634b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Sport injuries in the paediatric and adolescent patient: a growing problem. Pediatr Radiol 2009; 39:471-84. [PMID: 19277635 DOI: 10.1007/s00247-009-1191-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 01/12/2009] [Accepted: 01/28/2009] [Indexed: 10/21/2022]
Abstract
With an increasing number of paediatric and adolescent athletes presenting with injuries due to overuse, a greater demand is put on clinicians and radiologists to assess the specific type of injury. Repetitive forces applied to the immature skeleton cause a different type of injury than those seen in adults due to the differences in vulnerability of the musculoskeletal system, especially at the site of the growth cartilage. Intrinsic and extrinsic risk factors all play a role in the development of overuse injuries. MRI plays a key role in imaging overuse injuries due to its high potential for depicting cartilaginous and soft-tissue structures. Sport-specific biomechanics are described, since this knowledge is essential for adequate MRI assessment. An overview of several sport-related injuries is presented, based on anatomical location.
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Anderson HE, Roberts WO, Ronneberg K. Acute traumatic spine injury in a competitive snowboarder. Curr Sports Med Rep 2008; 7:319-22. [PMID: 19005352 DOI: 10.1249/jsr.0b013e31818ee45a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Harvey E Anderson
- St. John's Family Medicine Residency, University of Minnesota, Minneapolis, MN 55106, USA
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27
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Dunn AJ, Campbell RSD, Mayor PE, Rees D. Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis. Skeletal Radiol 2008; 37:443-50. [PMID: 18283450 DOI: 10.1007/s00256-008-0449-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 12/06/2007] [Accepted: 12/22/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective was to retrospectively record the CT and MRI features and healing patterns of acute, incomplete stress fractures of the pars interarticularis. METHOD The CT scans of 156 adolescents referred with suspected pars interarticularis stress fractures were reviewed. Patients with incomplete (grade 2) pars fractures were included in the study. Fractures were assessed on CT according to vertebral level, location of cortical involvement and direction of fracture propagation. MRI was also performed in 72 of the 156 cases. MRI images of incomplete fractures were assessed for the presence of marrow oedema and cortical integrity. Fracture healing patterns were characterised on follow-up CT imaging. RESULTS Twenty-five incomplete fractures were identified in 23 patients on CT. All fractures involved the inferior or infero-medial cortex of the pars and propagated superiorly or superolaterally. Ninety-two percent of incomplete fractures demonstrated either complete or partial healing on follow-up imaging. Two (8%) cases progressed to complete fractures. Thirteen incomplete fractures in 11 patients confirmed on CT also had MRI, and 92% demonstrated oedema in the pars. Ten out of thirteen fractures (77%) showed a break in the infero-medial cortex with intact supero-lateral cortex, which correlated with the CT findings. MRI incorrectly graded one case as a complete (grade 3) fracture, and 2 cases as (grade 1) stress reaction. Six fractures had follow-up MRI, 67% showed partial or complete cortical healing, and the same number showed persistent marrow oedema. CONCLUSIONS Incomplete fracture of the pars interarticularis represents a stage of the evolution of a complete stress fracture. The direction of fracture propagation is consistent, and complete healing can be achieved in most cases with appropriate clinical management. CT best demonstrates fracture size and extent, and is the most appropriate modality for follow-up. MRI is limited in its ability to fully depict the cortical integrity of incomplete fractures of the pars, but the presence of marrow oedema on fat-saturated T2-weighted sequences is a useful means of detecting acute spondylolysis.
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Affiliation(s)
- Andrew J Dunn
- Department of Medical Imaging, Royal Liverpool and Broadgreen University Teaching Hospitals, Prescot Street, Liverpool, L7 8XP, UK
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Abstract
Intervertebral disk herniation in pediatric patients is a rare but potentially disabling entity that is frequently difficult to diagnose. This article reviews the fundamentals of pediatric intervertebral disk herniation with the intention of presenting a rational and simple strategy for the evaluation and treatment of disk herniation in children, with specific emphasis on how it differs from adult disk disease in presentation, pathologic findings, and treatment options.
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Affiliation(s)
- Jonathan R Slotkin
- Department of Neurosurgery, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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McCleary MD, Congeni JA. Current concepts in the diagnosis and treatment of spondylolysis in young athletes. Curr Sports Med Rep 2007; 6:62-6. [PMID: 17212915 DOI: 10.1007/s11932-007-0014-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Spondylolysis is common among young athletes and should be suspected in any young athlete presenting with low back pain that persists for more than a few weeks. Diagnostic evaluation typically includes plain radiographs followed by more sensitive modalities, including single-photon emission CT, CT, or MRI. There is no consensus on the most appropriate protocol for diagnostic evaluation. Treatment usually consists of rest and/or bracing to allow healing to occur, followed by rehabilitation that includes core strengthening. More large-scale controlled studies need to be done in order to clarify the most effective diagnostic and therapeutic protocols.
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Affiliation(s)
- Michael D McCleary
- Akron Children's Hospital Sports Medicine Center, 388 S. Main Street, Suite 207, Akron, OH 44311, USA.
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Masci L, Pike J, Malara F, Phillips B, Bennell K, Brukner P. Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis. Br J Sports Med 2006; 40:940-6; discussion 946. [PMID: 16980534 PMCID: PMC2465027 DOI: 10.1136/bjsm.2006.030023] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Active spondylolysis is an acquired lesion in the pars interarticularis and is a common cause of low back pain in the young athlete. OBJECTIVES To evaluate whether the one-legged hyperextension test can assist in the clinical detection of active spondylolysis and to determine whether magnetic resonance imaging (MRI) is equivalent to the clinical gold standard of bone scintigraphy and computed tomography in the radiological diagnosis of this condition. METHODS A prospective cohort design was used. Young active subjects with low back pain were recruited. Outcome measures included clinical assessment (one-legged hyperextension test) and radiological investigations including bone scintigraphy (with single photon emission computed tomography (SPECT)) and MRI. Computed tomography was performed if bone scintigraphy was positive. RESULTS Seventy one subjects were recruited. Fifty pars interarticulares in 39 subjects (55%) had evidence of active spondylolysis as defined by bone scintigraphy (with SPECT). Of these, 19 pars interarticulares in 14 subjects showed a fracture on computed tomography. The one-legged hyperextension test was neither sensitive nor specific for the detection of active spondylolysis. MRI revealed bone stress in 40 of the 50 pars interarticulares in which it was detected by bone scintigraphy (with SPECT), indicating reduced sensitivity in detecting bone stress compared with bone scintigraphy (p = 0.001). Conversely, MRI revealed 18 of the 19 pars interarticularis fractures detected by computed tomography, indicating concordance between imaging modalities (p = 0.345). There was a significant difference between MRI and the combination of bone scintigraphy (with SPECT)/computed tomography in the radiological visualisation of active spondylolysis (p = 0.002). CONCLUSIONS These results suggest that there is a high rate of active spondylolysis in active athletes with low back pain. The one-legged hyperextension test is not useful in detecting active spondylolysis and should not be relied on to exclude the diagnosis. MRI is inferior to bone scintigraphy (with SPECT)/computed tomography. Bone scintigraphy (with SPECT) should remain the first-line investigation of active athletes with low back pain followed by limited computed tomography if bone scintigraphy is positive.
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Affiliation(s)
- L Masci
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia.
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Abstract
A large number of adolescents participate in various sports. Not withstanding the methodologic problems with epidemiologic data, a large percentage of athletes sustain musculoskeletal injuries. In most instances, the athlete first presents to his or her primary care physician, who must perform the initial assessment and decide on further management. Many injuries can be managed by the primary care physician. It is important to recognize the unique characteristics of adolescent growth and development that have implications for the diagnosis and management of musculoskeletal injuries.
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Affiliation(s)
- Dilip R Patel
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, Kalamazoo Center for Medical Studies, 1000 Oakland Drive, Kalamazoo, 49008, USA.
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Mac-Thiong JM, Labelle H. A proposal for a surgical classification of pediatric lumbosacral spondylolisthesis based on current literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15:1425-35. [PMID: 16758151 DOI: 10.1007/s00586-006-0101-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Revised: 01/18/2006] [Accepted: 03/06/2006] [Indexed: 10/24/2022]
Abstract
The classification presented in this paper is the first specifically designed to guide surgical treatment of L5-S1 spondylolisthesis in children and adolescents. It also presents objective criteria to differentiate between low- and high-dysplastic spondylolisthesis and incorporates recent knowledge in the study of sagittal spinopelvic balance. The proposed classification is based on the following: (1) the degree of slip, (2) the degree of dysplasia, and (3) the sagittal spinopelvic balance. To classify a patient, the degree of slip is quantified first to determine if it is low-grade, high-grade, or a spondyloptosis. Then, the degree of dysplasia is evaluated based on seven criteria, in order to separate patients with low- and high-dysplastic spondylolisthesis. Finally, the sagittal spinopelvic balance is assessed from the measurement of the pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). For low-grade spondylolisthesis, it is classified as low PI/low SS (nutcracker type) or high PI/high SS (shear type). For high-grade spondylolisthesis, it is classified as high SS/low PT (balanced pelvis) or low SS/high PT (retroverted pelvis). Such a comprehensive classification could allow to better evaluate and compare available surgical techniques, and to optimize the treatment of L5-S1 spondylolisthesis. Because the classification was designed so that groups are organized in an ascending order of severity, it becomes easier and more intuitive to develop an associated surgical algorithm because the complexity of the surgery should increase as the severity of the spondylolisthesis increases. A tentative treatment algorithm is proposed but it is not definitive because further studies are required to define the most appropriate treatment for each group.
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Abstract
The conditions described for the most part are diagnosed by characteristic history, comprehensive physical examination, and selective laboratory and imaging studies. Most can be treated by nonoperative means. With the exception of tumors, surgical intervention is performed only after a thorough trial of conservative management. Should the diagnosis remain elusive or response to treatment less than expected, orthopedic referral is encouraged.
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Affiliation(s)
- Gerard L Glancy
- Department of Orthopaedics, The Children's Hospital, 1056 East 19th Avenue, Denver, CO 80218, USA.
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Abstract
Though athletes may be able to return to their sport after treatment of spondylolysis and spondylolisthesis, prevention of back injury in at-risk patient athletes should be the treating physician's primary goal.
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Scudder L, Crowther CL. Pars Defects in Adolescents. J Nurse Pract 2005. [DOI: 10.1016/j.nurpra.2005.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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