Analysis of MRI signal changes in the adjacent pedicle of adolescent patients with fresh lumbar spondylolysis

Goda, Yuichiro; Sakai, Toshinori; Sakamaki, Tadanori; Takata, Yoichiro; Higashino, Kosaku; Sairyo, Koichi

doi:10.1007/s00586-013-3109-6

Cited by 34 publications

(28 citation statements)

References 13 publications

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“…L5 is the most frequent lesion level for lumbar spondylolysis [10]. The union rate of L5 lesions is lower than that for other levels [11,12]. In the present study, we also found that the rate of lesion union at the level of L5 was signi cantly lower than that for other levels.…”

Section: Discussionsupporting

confidence: 65%

Factors Associated with Failure of Bony Union After Conservative Treatment of Acute Cases of Unilateral Lumbar Spondylolysis

Tatsumura

Gamada

Okuwaki

et al. 2020

Preprint

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Background: If bone union is expected, conservative treatment is generally selected for lumbar spondylolysis. However, sometimes conservative treatments are unsuccessful. We sought to determine the factors associated with failure of bony union in acute unilateral lumbar spondylolysis with bone marrow edema including contralateral pseudoarthrosis.Methods: This study targeted unilateral lumbar spondylolysis treated conservatively in high school or younger students. Conservative therapy was continued until the bone marrow edema disappeared on MRI and bone union was investigated by CT. We conducted a univariate analysis of sex, age, pathological stage, lesion level complicating the contralateral bone defect, lesion level, and intercurrent spina bifida occulta, and variables with p < 0.1 were considered in a logistic regression analysis. An item with p < 0.05 was defined as a factor associated with failure of bony union.Results: We found 92 cases of unilateral spondylolysis with bone marrow edema and 66 cases were successfully treated conservatively. Failure of bony union in unilateral lumbar spondylolysis with bone marrow edema was associated with advanced pathological stage (p = 0.004), contralateral pseudoarthrosis (p < 0.001), and L5 lesion level (p = 0.002). The odds ratio was 20.0 (95% CI 3.0–193.9) for advanced pathological stage, 78.8 (95% CI 13–846) for contralateral pseudoarthrosis, and 175 (95% CI 8.5–8192) for L5 lesion level.Conclusions: Conservative therapy aiming at bony union is contraindicated in cases of acute unilateral spondylolysis when the pathological stage is advanced, the lesion level is L5, or there is contralateral pseudoarthrotic spondylolysis.

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Section: Discussionsupporting

confidence: 65%

Factors Associated with Failure of Bony Union After Conservative Treatment of Acute Cases of Unilateral Lumbar Spondylolysis

Tatsumura

Gamada

Okuwaki

et al. 2020

Preprint

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“…The use of radiographs improves the early diagnosis of lumbar spondylolysis. 9,11,12 In addition, differences in the ethnic groups of the subjects may have affected the results. 13 The prevalence of lumbar spondylolysis in the 3 age groups included in the current study showed that approximately half of elementary school and junior high school students and one third of high school students had a positive diagnosis, and all of those with spondylolysis had a history of athletic activity.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Symptomatic Lumbar Spondylolysis in Pediatric Patients

Nitta¹,

Sakai²,

Goda³

et al. 2016

Orthopedics

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Lumbar spondylolysis, a stress fracture of the pars interarticularis, is prevalent in adolescent athletes. Recent advances in diagnostic tools and techniques enable early diagnosis before these fractures progress to complete fractures through the pars. However, because patients often consult family physicians for primary care of low back pain and these physicians may not have access to diagnostic modalities such as magnetic resonance imaging (MRI) and computed tomography, stress fractures can be missed. This study surveyed the prevalence of symptomatic spondylolysis in pediatric patients who consulted an orthopedic clinic for primary care and investigated whether such acute stress fractures may be overlooked without MRI. The prospective study investigated 264 patients who were younger than 19 years and had low back pain. Of the 153 patients (58.0%) with low back pain persisting for longer than 2 weeks, 136 who agreed to undergo MRI were included in the study. This group included 11 elementary school students, 71 junior high school students, and 54 high school students. The overall prevalence of lumbar spondylolysis was 39.7% (54 of 136) and was 9.3% in elementary school students (5 of 11, 45.5%), 59.3% in junior high school students (32 of 71, 45.1%), and 31.5% in high school students (17 of 54, 31.5%). All 54 patients with spondylolysis had a history of athletic activity. Primary care physicians should recognize that approximately 40% of pediatric patients presenting with low back pain persisting for longer than 2 weeks may have spondylolysis and should consider MRI in those with a history of athletic activity. Because the spine is immature in this age group, almost half of affected elementary school and junior high school students may have lumbar spondylolysis. [Orthopedics. 2016; 39(3):e434-e437.].

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“…3 History of athletic activity and symptoms at the first consultation. a Two patients had no such history at the first consultation and b two patients had been diagnosed incidentally from abdominal plain X-rays that had been taken for investigation of an acute abdomen Eur Spine J can heal spontaneously or more easily with conservative treatment before the fracture of the pars interarticularis is complete [14]. Thus, there may be a distinct pathomechanism for spondylolysis at L5 and at other levels.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of lumbar spondylolysis in elementary school age children

et al. 2015

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Analysis of MRI signal changes in the adjacent pedicle of adolescent patients with fresh lumbar spondylolysis

Abstract: MRI revealed a higher prevalence of L3 or L4 spondylolysis than observed with CT.

Cited by 34 publications

References 13 publications

Factors Associated with Failure of Bony Union After Conservative Treatment of Acute Cases of Unilateral Lumbar Spondylolysis

Factors Associated with Failure of Bony Union After Conservative Treatment of Acute Cases of Unilateral Lumbar Spondylolysis

Prevalence of Symptomatic Lumbar Spondylolysis in Pediatric Patients

Characteristics of lumbar spondylolysis in elementary school age children

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