Bone Healing in Adolescents with Bilateral L5 Spondylolysis with and without Preexisting Contralateral Terminal Spondylolysis

Eto, Fumihiko; Tatsumura, Masaki; Gamada, Hisanori; Okuwaki, Shun; Koda, Masao; Yamazaki, Masashi

doi:10.31616/asj.2020.0309

Cited by 4 publications

(7 citation statements)

References 12 publications

(14 reference statements)

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“…Many risk factors for bone healing have been reported in the conservative treatment of adolescent lumbar spondylolysis, including progressive, L5, bilateral, and contralateral terminal-stage lesions [ 3 , 5 , 10 , 11 ]. Many reports describe lesions that do not respond well to conservative treatment, such as progressive-stage lesions with a contralateral terminal-stage lesion [ 10 , 11 ]. In contrast, there have been few reports of lesions with good outcomes and lesions with consistent bone healing.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, the bone healing rate of pre-lysis-stage lesions was 95%, with 5% of the lesions failing to heal. Bilateral lesions have been reported as a risk factor for conservative treatment in previous studies involving all stages of the disease [ 3 , 5 , 11 ]. Even in pre-lysis-stage lesions, the bone healing rate in bilateral lesions is lower than in unilateral lesions.…”

Section: Discussionmentioning

confidence: 99%

“…According to previous reports, a terminal-stage lesion on the contralateral side of a fresh lesion is common [ 10 , 11 ]. This demonstrates that based on the timeline, the unilateral lesion progresses to the terminal stage, and then a fresh lesion develops on the contralateral side.…”

Section: Discussionmentioning

confidence: 99%

“…This demonstrates that based on the timeline, the unilateral lesion progresses to the terminal stage, and then a fresh lesion develops on the contralateral side. Furthermore, conservative treatment has a very poor outcome in cases of the contralateral terminal-stage lesion [ 8 , 10 , 11 ]. We believe that treating the initial unilateral lesion is critical for preventing such cases.…”

Section: Discussionmentioning

confidence: 99%

“…Because most patients are referred to our hospital by their primary care physicians for a comprehensive adolescent examination, MRI is used in all cases, except those involving obvious trauma, as it has previously been reported to be useful for early diagnosis and prevention of missed lesions [ 4 , 9 ]. Furthermore, in cases where MRI shows high-intensity changes within the pedicle, CT is performed because bone fusion rates in lumbar spondylolysis vary greatly depending on the stage (e.g., 94% in early stage, 80% in progressive stage, and 0% in terminal stage), and stage diagnosis can only be performed by CT, as many reports have shown [ 1 , 3 , 5 , 7 , 8 , 10 , 11 ].…”

Section: Methodsmentioning

confidence: 99%

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Conservative Treatment and Unfavorable Factors to Bone Healing of “Pre-lysis”-Stage Lumbar Spondylolysis in Adolescents

et al. 2023

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To evaluate the clinical outcomes of the conservative treatment of "pre-lysis"-stage lumbar spondylolysis. Overview of Literature: With the widespread use of magnetic resonance imaging (MRI) for early diagnosis of lumbar spondylolysis, a new disease stage called pre-lysis has emerged, in which intensity change is observed only on MRI without a fracture line on computed tomography. This study aimed to evaluate the clinical outcomes and factors unfavorable to bone healing of the conservative treatment of pre-lysis-stage lumbar spondylolysis. Methods: Fifty-three patients with 57 fresh pre-lysis-stage lesions who had completed conservative treatment were included in the study (40 men, 13 women; mean age, 14.3 years). We investigated the rate of bone healing and the relationship between bone healing after conservative therapy and factors such as age, sex, vertebral level, unilateral/bilateral lesions, and presence of spina bifida occulta. Results:The overall bone healing rate was 95% (54/57 lesions). Bilateral lesions had a significantly lower bone healing rate than unilateral lesions (86% vs. 100%, p=0.046). There were no statistically significant differences based on age, sex, vertebral level, or presence of spina bifida occulta. Conclusions:The bone healing rate in unilateral lesions was 100%, which was significantly higher than that in bilateral lesions. It is important to detect and initiate treatment while the lesion is still unilateral, if possible.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Conservative Treatment and Unfavorable Factors to Bone Healing of “Pre-lysis”-Stage Lumbar Spondylolysis in Adolescents

et al. 2023

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Characteristics of lumbar spondylolysis: L5 versus non-L5

Gamada,

Tatsumura,

Okuwaki

et al. 2024

BMC Musculoskelet Disord

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Background Fifth lumbar vertebra (L5) spondylolysis has a lower bone union rate than non-L5 spondylolysis, but the reason for this is unknown. This study aimed to evaluate the differences in patient and lesion characteristics between L5 and non-L5 spondylolysis. Methods A total of 410 patients with lumbar spondylolysis aged 18 years or younger who were treated conservatively were enrolled. Patients and lesions were divided into L5 and non-L5 (L2–L4) spondylolysis. Factors, including sex, age, presence of spina bifida occulta, stage of the main side lesion, whether the lesion was unilateral or bilateral, presence and stage of the contralateral side lesion and treatment duration, were evaluated at the first visit and compared between the two groups. Results A total of 250 patients with 349 lesions were included. The bone union rate of L5 lesions was lower than that of non-L5 lesions (75% vs. 86%, p = 0.015). Patients with L5 spondylolysis were more likely to be male (86% vs. 66%) and younger (14.0 vs. 14.6 years) than patients with non-L5 spondylolysis. Lesions of L5 spondylolysis were more likely to be in a progressive stage (28% vs. 15%), less likely to be in a pre-lysis stage (28% vs. 43%) and more likely to be in a contralateral terminal stage (14% vs. 5.3%, p = 0.013) compared with lesions of non-L5 spondylolysis. Conclusions L5 spondylolysis was characterised by a lower bone union rate, more males, younger age, more progressive stage and more contralateral pseudarthrosis than non-L5 spondylolysis.

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Main and contralateral side stages of lesion affected bone union in the conservative treatment of adolescent lumbar spondylolysis: a multivariable analysis of 217 patients and 298 lesions in a retrospective cohort study

et al. 2023

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Background Factors affecting bone union in the conservative treatment of adolescent lumbar spondylolysis remain controversial. We aimed to examine these factors along with advances in diagnostic imaging using multivariable analysis of a sufficient number of patients and lesions. Methods In this retrospective study, high-school-aged patients or younger (n = 514) who were diagnosed with lumbar spondylolysis from 2014 to 2021 were investigated. We included patients with acute fractures who showed signal changes around the pedicle on magnetic resonance imaging and who completed conservative treatment. The following factors were investigated at the initial visit: age, sex, level of lesion, main side stage, presence and stage of contralateral side lesion, and presence of spina bifida occulta. The association of each factor with bone union was evaluated through a multivariable analysis. Results Altogether, 298 lesions in 217 patients (174 boys and 43 girls; mean age: 14.3 years) were included in this study. Multivariable logistic regression analysis of all factors showed that the main side progressive stage was more likely associated with nonunion as compared to the pre-lysis (OR: 5.86; 95% confidence interval [CI]: 2.00–18.8; p = 0.0011) and early stages (OR: 3.77; 95% CI: 1.72–8.46; p = 0.0009). Regarding the contralateral side stage, the terminal stage was more likely to be associated with nonunion. Conclusion In the conservative treatment of lumbar spondylolysis, the factors affecting bone union were the main and contralateral side stages. Sex, age, level of lesion, or spina bifida occulta had no significant effects on bone union. The main, progressive, and contralateral side terminal stages were negative predictors of bone union. Trial registration This study was retrospectively registered.

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Bone Healing in Adolescents with Bilateral L5 Spondylolysis with and without Preexisting Contralateral Terminal Spondylolysis

Cited by 4 publications

References 12 publications

Conservative Treatment and Unfavorable Factors to Bone Healing of “Pre-lysis”-Stage Lumbar Spondylolysis in Adolescents

Conservative Treatment and Unfavorable Factors to Bone Healing of “Pre-lysis”-Stage Lumbar Spondylolysis in Adolescents

Characteristics of lumbar spondylolysis: L5 versus non-L5

Main and contralateral side stages of lesion affected bone union in the conservative treatment of adolescent lumbar spondylolysis: a multivariable analysis of 217 patients and 298 lesions in a retrospective cohort study

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