Natural History of Lumbar Spondylolysis-Advances and Concerns

Abstract

Lumbar spondylolysis is a common cause of low back pain in adolescents and young adults. Due to a lack of understanding to the natural history, its treatment is often chaotic and controversial. Lumbar spondylolisthesis is a common complication of spondylolysis, but slip progression was commonly small and slow according to long-term follow-up studies. Many predisposing risk factors have been identified as associated with a great chance of slip progression. However, the widely accepted mechanism leading to adult slip progression is related to disc degeneration at the slip level. Clinical decision made for patients presenting with spondylolysis and spondylolisthesis principally include concerns for future progression of the spondylolisthesis and issues concerning pain. Most patients with spondylolysis and/or spondylolisthesis respond to conservative treatment. Surgical treatment is generally thought for patients who fail to respond to conservative treatment.

A rare case of multilevel spondylolysis—A nineteenth century Chinese immigrant to Peru from Castillo de Huarmey archaeological site

“…It is higher in males than in females (2:1). In the American as well as Japanese populations, the incidence was reported to be close to 6%, whereas in the Eskimo, it has reached 50%, and among part of population engaged in certain, high impact sports, it was as high as 63% (Peng, 2016).…”

“…The most frequent is spondylolysis involving the fifth lumbar vertebra L5 (up to 95% of all cases), although it may occur also in other vertebrae from this region, usually with decreasing frequency from the inferior to the superior lumbar spine (Peng, 2016;Wright et al, 2013). If it occurs in more than one vertebra, it is called a multilevel spondylolysis.…”

“…Spondylolysis is a bony defect on vertebra where the dorsal aspect of the neural arch is separated from the rest of the vertebra with a fracture occurring in the portion of the neural arch, between the superior and inferior articular facets, called pars interarticularis of the vertebra (Peng, 2016;Wright et al, 2013). This separation may occur bilaterally, separating the vertebral body from the neural arch or, unilaterally, showing this defect only on one side of the neural arch (Leone et al, 2011).…”

“…There are also reports suggesting the likelihood of the presence of spondylolysis in association with other skeletal defects or disorders, especially spondylolisthesis, spina bifida and, among others, also osteoporosis imperfecta or neurofibromatosis (Lubicky, 2005;Verra et al, 2009). or hyperextension as the main cause of spondylolysis (Peng, 2016). It has been observed in athletes (Hanke et al, 2018;Koerner & Radcliff, 2013), football players (Semon & Spengler, 1981) and physical education students (Park et al, 2009), military (Celtikci et al, 2018;Dunn et al, 2009), mine workers (Meyer & Steyn, 2015) but also among the individuals without such life history.…”

Sacrum Paleopathology in Hunter-Gatherers From Southern Patagonia

“…Nevertheless, hereditary predisposition of the vertebral structure (Wynne-Davies and Scott 1979;Yamada et al 2013) and SBO (Fredrickson et al 1984;Wynne-Davies and Scott 1979) have been also suggested as influential factors for developing this pathology. To date, its etiology has been multifactorial, including causes such as a stress fracture linked to congenital weakness of the pars interarticularis in some cases (Krenz and Troup 1973;Peng 2016;Ward et al 2010). SL is asymptomatic in most cases, but back pain may be present, particularly when displacement of the vertebrae occurs, a disorder known as spondylolisthesis (Haun and Kettner 2005), although the etiopathogenesis of both conditions are different (Merbs 1996a).…”