Clinical features of patients with pars defects identified in adulthood

Sakai, Toshinori; Goda, Yuichiro; Tezuka, Fumiaki; Abe, Mitsunobu; Yamashita, Kazuo; Takata, Yoichiro; Higashino, Kosaku; Nagamachi, Akihiro; Sairyo, Koichi

doi:10.1007/s00590-015-1727-x

Cited by 11 publications

(9 citation statements)

References 17 publications

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“…The risk factors for non-union in the patients with lumbar spondylolysis are multifactorial. Sakai et al [25] reported that patients with L5 spondylolysis and spina bifida occulta have predisposing factors in the development of terminal-stage spondylolysis. In order to analyze the detail of the correlation between the CR and bone union, we need to conduct studies on a larger sample in the future.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Assessment of Bone Marrow Edema in Adolescent Athletes with Lumbar Spondylolysis Using Contrast Ratio on Magnetic Resonance Imaging

et al. 2021

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Study Design: Prospective cohort study.Purpose: To quantitatively evaluate bone marrow edema (BME) in the pedicle on magnetic resonance imaging (MRI) for adolescent athlete patients with spondylolysis.Overview of Literature: Spondylolysis, a stress fracture of the pars interarticularis, is a common occurrence in adolescent athletes with low back pain. T2-weighed fat-saturated MRI is reportedly useful for the detection of BME in the pedicle in the early stage of spondylolysis; however, to our knowledge, the quantitative assessment of BME in spondylolysis has not been reported.Methods: Adolescent athletes with spondylolysis, including those with symptoms of low back pain, were enrolled. The sporting activity of the patients was restricted, and a hard brace was attached to the spine. The BME range of interest was taken on T2-weighed fat-saturated MRI, and the signal intensity (SI) of the BME (SIedema) was measured. The contrast ratio (CR) between the SI of the BME and SI of the spinal cord (SIcord) was calculated per the following formulae: CRedema=(SIedema–SIcord)/(SIedema+SIcord). The CR of the normal pedicle was measured as a control per the following formulae: CRcontrol=(SIcontrol–SIcord)/(SIcontrol+SIcord).Results: The study enrolled 32 men and one woman; the mean patient age was 15.2 years (range, 12–18 years). The average CR of the edema and normal pedicle at the first visit was 0.506 (range, 0.097–0.804) and 0.137 (range, -0.741 to 0.572), respectively. The CR of the edema was significantly higher as compared to that of the normal pedicle (p<0.01). MRI that was performed 1 month after the first visit showed that the CR of the edema had decreased to 0.204 (range, -0.152 to 0.517). The CR of the edema 1 month thereafter was significantly lower than that at the first visit (p<0.01).Conclusions: Quantitative assessment of BME using CR on MRI is useful in the evaluation of the healing process of spondylolysis.

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Section: Discussionmentioning

confidence: 99%

Quantitative Assessment of Bone Marrow Edema in Adolescent Athletes with Lumbar Spondylolysis Using Contrast Ratio on Magnetic Resonance Imaging

et al. 2021

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“…However, about 90% of end-stage L5 spondylolysis patients are first diagnosed in adulthood. In addition, about 40% of cases had no sports history or low back pain experience in their growth period[ 12 ]. If patients with lumbar spondylolysis have low back pain, conservative treatment is ineffective, or imaging shows spondylolisthesis, surgical treatment is required[ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of four segment lumbar spondylolysis: A case report

Li¹,

Peng²

2021

WJCC

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BACKGROUND Four-level lumbar spondylolysis is extremely rare. So far, only 1 case has been reported in the literature. CASE SUMMARY A 19-year-old man presented with severe back pain irresponsive to conservative therapies for 2 years. Lumbar radiographs and two-dimensional computed tomography scan showed four segment lumbar spondylolysis on both sides of L2-L5. Lumbar magnetic resonance imaging showed normal signal in all lumbar discs. Because daily activities were severely limited, surgery was recommended for the case. The patient underwent four-level bilateral isthmic repair at L2-L5. During surgery, L2-L5 isthmi were curetted bilaterally, freshened, and then grafted with autologous iliac bone that was bridged and compressed with a pedicular screw connected to a sub-laminar hook by a short rod. The symptoms of back pain almost disappeared. He has been followed-up for 96 mo, and his symptoms have never recurred. Fusion was found in all repaired isthmi 14 mo after surgery according to evaluation of lumbar radiography and computed tomography scan. CONCLUSION We report here 1 case of four-level lumbar spondylolysis that was treated successfully with direct isthmic repair.

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“…SBO is caused by failure of fusion between posterior vertebral elements without affecting the spinal cord or meninges. It is usually observed at L5 and/or at the upper one or lower two sacral vertebrae [1,2]. Goto et al reported a case of SBO at the thoracolumbar junction and estimated the incidence as <5% within all SBO patients [6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Spina bifida occulta (SBO) is a common malformation of the lamina of the spine, most commonly occurring in the sacrum or lower lumbar spine [1,2]. Spondylolysis is a common etiology of back pain in children and adolescents.…”

Section: Introductionmentioning

confidence: 99%

Spina Bifida Occulta with Bilateral Spondylolysis at the Thoracolumbar Junction Presenting Cauda Equina Syndrome

Mataki

Koda

Shibao

et al. 2020

Case Reports in Orthopedics

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Several reports have described the coexistence of spina bifida occulta (SBO) and spondylolysis, but the majority of defects occur at L5. No report has described the coexistence of SBO and spondylolysis at the thoracolumbar junction. We report a case of SBO with spondylolysis at L1, presenting cauda equine syndrome. A 37-year-old man presented with a gait disorder as a result of bilateral motor weakness of the lower extremities. A plain radiograph showed local kyphosis at L1-2 as a result of severe degenerative change and wedging of the vertebral body at L1. Magnetic resonance imaging (MRI) revealed degenerative disc changes and severe canal stenosis at L1-2. Computed tomography (CT) revealed SBO and spondylolysis at L1. He was diagnosed with cauda equina syndrome related to SBO and spondylolysis at L1. Posterior interbody fusion and decompression at L1-2 were performed. After surgery, his muscle power recovered to normal strength. The possible mechanisms in this case are the strain on anterior elements as a result of disruption of the posterior elements due to SBO and spondylolysis. The coexistence of SBO and spondylolysis at the thoracolumbar junction might induce at-risk status of increased strain to the anterior elements that may cause cauda equina syndrome.

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Clinical features of patients with pars defects identified in adulthood

Cited by 11 publications

References 17 publications

Quantitative Assessment of Bone Marrow Edema in Adolescent Athletes with Lumbar Spondylolysis Using Contrast Ratio on Magnetic Resonance Imaging

Quantitative Assessment of Bone Marrow Edema in Adolescent Athletes with Lumbar Spondylolysis Using Contrast Ratio on Magnetic Resonance Imaging

Surgical treatment of four segment lumbar spondylolysis: A case report

Spina Bifida Occulta with Bilateral Spondylolysis at the Thoracolumbar Junction Presenting Cauda Equina Syndrome

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