Fracture of the Pars Interarticularis in Adolescent Athletes

Letts, Merv; Smallman, T. V.; Afanasiev, Ron; Gouw, Gerard J.

doi:10.1097/01241398-198601000-00009

Cited by 137 publications

(48 citation statements)

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“…In the clinical literature, spondylolysis has been associated with activities that involve repetitious, vigorous exercise, such as gymnastics (Jackson et al, 1976;Goldberg, 1980;Hooper, 1984;Ciullo and Jackson, 1985;Bozdech and Dukek, 1986;Letts et al, 1986;Commandre et al, 1988), contortionism (Steinbuck and Springorum, 1980), dancing (Micheli, 1983;Bejjani, 1987), diving (Rossi and Dragoni, 1990), hockey (Letts et al, 19861, javelin throwing (Feldmeier et al, 1985;Bejjani, 1987;Chapman, 1987), rowing (Stallard, 1980), canoeing (Jakab, 1989), football (Ferguson et al, 1974;Alexander, 1985;McCarroll et al, 1986), handball (Hoshina, 1980), weight lifting (Kotani et al, 1971;Granhed and Morelli, 1988;Risser, 1991), and wrestling (Rossi and Dragoni, 1990).…”

Section: Discussionmentioning

confidence: 99%

Spondylolysis of the sacrum in Alaskan and Canadian Inuit skeletons

Merbs

1996

Am. J. Phys. Anthropol.

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Spondylolysis of the lower back, particularly that involving the isthmus between the superior and inferior articular processes (pars interarticularis), is generally attributed to stress fracturing caused by movement of the affected vertebra relative to the vertebra below. The finding of isthmic spondylolysis in the first vertebra of a fused sacrum is thus unusual and requires explanation. Although unrepresented in the clinical literature, sacral spondylolysis has been reported for archaeological specimens and appears to be especially prevalent in North American Inuit. A study of 373 Inuit sacra from Alaska and Canada produced 16 examples of spondylolysis (eight from each area). All but one of the affected individuals were male, and nearly all were young adults, many between 18 and 20 years of age. All cases of sacral spondylolysis observed in this study were judged to have resulted from stress fracturing that occurred while S1 was still unfused, and most appear to have been in the process of healing, following fusion of S1 with S2, when death occurred. The high frequency observed in these people is attributed to unusual stresses becoming concentrated in the lower back of adolescent males due to such activities as weight lifting, wrestling, kayak paddling, and harpooning, combined with, and perhaps even contributing to, delayed maturation (S1-S2 fusion) of the sacrum.

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Section: Discussionmentioning

confidence: 99%

Spondylolysis of the sacrum in Alaskan and Canadian Inuit skeletons

Merbs

1996

Am. J. Phys. Anthropol.

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“…Fibrous healing occurs and may lead to a good clinical result [5,25,29]. Once chronic spondylolysis is noted, sports can be resumed, but repetitive activities with high demands on the lumbar spine should be avoided [9,30].…”

Section: Discussionmentioning

confidence: 99%

“…Although genetic and racial factors may predispose an individual to spondylolysis [13,15,40], the most generally favored theory is that spondylolysis is a fracture caused by mechanical stress, and that the mode of failure is fatigue [6,7,21,29,41,50,51]. The mechanical etiology of this fatigue fracture is controversial, and many experimental studies have been carried out to determine the fatigue strength of the pars interarticularis and to delineate the movements causing failure [1,10,11,12,28,32].…”

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confidence: 99%

“…Experiments on cadaveric lumbar motion segments have shown that full flexion and extension movements bend the inferior articular process sufficiently to cause a fatigue fracture of the pars interarticularis [17]. The likelihood of fatigue failure would be greater in activities that require alternating flexion and extension of the lumbar spine, because this would involve large stress reversals in the pars interarticularis [17,29]. Movements of this type occur in gymnastics, pole vaulting, volley ball, etc.…”

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confidence: 99%

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Nonoperative treatment of active spondylolysis in elite athletes with normal X-ray findings: literature review and results of conservative treatment

et al. 2001

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“…It is unique to humans and viewed as a stress fracture in the pars area of a lower lumbar vertebra, caused primarily by repetitive habitual or strenuous movements involving lateral flexion and hyperextension of the lower back (Wiltse et al, 1975;Letts et al, 1986;Merbs, 1996b). Related to upright human posture, it only occurs after an individual has started to walk (Merbs, 1989: 170).…”

Section: Introductionmentioning

confidence: 96%

Prevalence rates of spondylolysis in British skeletal populations

Fibiger

Knüsel

2005

Int. J. Osteoarchaeol.

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As an activity-related pathological lesion, spondylolysis and its prevalence rates are indicative of relative diachronic activity levels in different populations. In this paper we document the prevalence of spondylolytic defects in a series of time-successive populations with special reference to the recording methods employed, and compare the findings with modern clinical studies. We identify epidemiological trends in expression of the condition through 1500 years in a series of skeletonised human remains from England. This includes a 5th-6th-century settlement, a 15th-century mass grave, a 14th to 17th-century rural parish, a medieval Dominican friary, a medieval leper hospital and an 18th to 19th-century crypt collection. These skeletal populations sample human groups experiencing considerable social change from an agrarian, non-centralised early medieval period through the development of the medieval state to the earliest phases of industrialisation in England. A detailed study of all lumbar vertebrae in one of the assemblages highlights discrepancies between clinical prevalence rates for spondylolysis established through radiography, and those resulting from direct osteological analysis of the lumbar region of the vertebral column. Current prevalence rates cited in the osteological as well as the clinical literature are greatly dependent upon the recording methods employed, and the effects of several methods for osteological remains are considered in this treatment. For the populations reported on here, prevalence rates vary from considerably less than 1% to as much as 12%, depending on the method selected. A standardised recording method for spondylolytic lesions is suggested to facilitate accurate prevalence reporting and comparison of activity levels between different populations.

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Fracture of the Pars Interarticularis in Adolescent Athletes

Cited by 137 publications

References 0 publications

Spondylolysis of the sacrum in Alaskan and Canadian Inuit skeletons

Spondylolysis of the sacrum in Alaskan and Canadian Inuit skeletons

Nonoperative treatment of active spondylolysis in elite athletes with normal X-ray findings: literature review and results of conservative treatment

Prevalence rates of spondylolysis in British skeletal populations

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