Facture of the Pars Interarticularis with or without Spondylolisthesis in an Adult Population in a Developing Country: Evaluation by Multidetector Computed Tomography

Abstract

Study DesignDescriptive cross-sectional study.PurposeTo determine the prevalence of lumbar spondylolysis and spondylolisthesis in a general adult population unrelated to lower back pain as evaluated by multidetector computed tomography.Overview of LiteratureThere is a significant paucity of information related to the prevalence of spondylolysis and spondylolisthesis and its degenerative changes in a general adult population unrelated to lower back pain in developing countries.MethodsA retrospective study was conducted on abdominopelvic computed tomography (CT) scans performed between January 1st 2015 and December 31st 2015 for various clinical indications. Patients with lower back pain, with a history of trauma or road traffic accident, or referred from orthopedic or neurosurgery departments were excluded to avoid any bias. CT scans were reviewed in axial, sagittal, and coronal planes using bone window settings for evaluating spondylolysis and spondylolisthesis.ResultsOf 4,348 patients recruited, spondylolysis and spondylolisthesis were identified in 266 (6.1%) and 142 (3.3%) patients, respectively. Age was significantly higher in both spondylolysis and spondylolisthesis patients than in those without spondylolysis and spondylolisthesis (47.19±15.45 vs. 42.5±15.96, p<0.001 and 53.01±15.31 vs. 42.44±15.88, p<0.001, respectively). Gender was significantly associated with spondylolisthesis (p=0.029) but not spondylolysis. Of patients who were >60 years old, both spondylolysis (p=0.018) and spondylolisthesis (p=0.025) were significantly more prevalent in females.ConclusionsThe prevalence of pars interarticularis fracture observed higher with gradual increase in the prevalence with advancing age. In particular, preponderance was significantly higher among older females.

Evaluation of Incidental Lumbar Spondylolysis by Computed Tomography

“…According to Sohail et al the prevalence of incidental spondylolysis was 6, 1% in large community based population in Pakistan, a developing Asian country. [7] Similarly study by Belfi et al showed a prevalence of 5.7% spondylolysis on examining 510 consecutive patients with abdomen CT.…”

Isthmic spondylolisthesis: the current state of the problem

“…Введение в широкую практику метода КТ позволило не только с высокой точностью выявлять СЛ, но и определять его вид. При ИСЛ в определении дефекта межсуставной части дуги важна КТ, также она позволяет точно определить размер межпозвонкового отверстия и сделать вывод о компрессии корешка спинномозгового нерва [50]. Практически полное отсутствие ограничений метода КТ, исчерпывающая информация о костной анатомии, возможность определения параметров смещения позвонка сделали данное исследование обязательным при планировании оперативного вмешательства по поводу ИСЛ.…”

Analysis of clinical and radiological outcomes of posterior dynamic stabilization for direct repair of bilateral l5 pars interarticularis defect: dynamic assessment of pars fusion

“…dosis or hyperlordosis may cause abnormal stresses on the spine that may cause these anatomical defects, including a crack, fracture, or separation (15,35). High pelvic incidence (PI) and sacral slope (SS) (>40°) values increase shear forces on the L5-S1 disc and increase strain on the pars interarticularis of the L5 vertebra during the development of spondylolysis and low-grade developmental spondylolisthesis.…”

“…Moreover, disc degeneration at the level of the pars interarticularis defect (surgical segment disc) is generally an accompanying disorder in patients with spondylolysis. Loss of bone integrity in the pars interarticularis can increase the load on the disc at the level of spondylolysis and may cause degeneration (15,35). Some recently published studies have shown that dynamic stabilization, using a dynamic rod system, provides stability similar to rigid systems but without the complication of spinal fusion (12).…”