Radiographic Assessment of Lumbar Facet Distance Spacing and Pediatric Spondylolysis

Zehnder, Scott W.; Ward, Carol V.; Crow, Austin J.; Alander, Dirk H.; Latimer, Bruce

doi:10.1097/brs.0b013e3181956053

Cited by 13 publications

(11 citation statements)

References 11 publications

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“…The boundary of bone and soft tissue is demarcated by dotted lines. 47 Collectively, our findings and many others emphasize an undeniable role of anatomic abnormalities in the isthmus or adjacent bony structures together with consequently altered biomechanics in development of spondylolysis. C, Representative images of alkaline phosphatase staining of cultured BMSCs under osteogenic condition.…”

Section: Discussionsupporting

confidence: 68%

“…30 This finding is consistent with the previous study where a total of 509 fetal specimens were examined and displayed neither isthmic crack nor separate neural arch. 15,[47][48][49][50] One good example is a study where the transverse interfacet distance was measured among 39 patients with spondylolysis and compared to 42 adults without spondylolysis. A, Representative calcein double labeling images of isthmus in the junctional region (boxed area) between the ventral and dorsal part of the vertebra.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, multiple experiments have indicated that morphological changes could increase the risk of developing cracked pars. 15,[47][48][49][50] One good example is a study where the transverse interfacet distance was measured among 39 patients with spondylolysis and compared to 42 adults without spondylolysis. 48 An inadequate distance gain of the transverse interfacet from the L3-L4 to the L5-S1 facet joints was observed in patients compared to controls, which increased susceptibility to pars fractures under repetitive hyperextension of lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

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Phenotypic characterization of Slc26a2 mutant mice reveals a multifactorial etiology of spondylolysis

et al. 2019

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Confusion persists over pathogenesis of spondylolysis. To confirm pathogenicity of the previously identified causative mutation of spondylolysis and investigate the genetic etiology, we generate a new mouse line harboring D673V mutation in the Slc26a2 gene. D673V mutation induces delayed endochondral ossification characterized by transiently reduced chondrocyte proliferation in mice at the early postnatal stage. Adult D673V homozygotes exhibit dysplastic isthmus and reduced bone volume of the dorsal vertebra resembling the detached vertebral bony structure when spondylolysis occurs, including the postzygopophysis, vertebral arch, and spinous process, which causes biomechanical alterations around the isthmic region of L4‐5 vertebrae indicated by finite element analysis. Consistently, partial ablation of Slc26a2 in vertebral skeletal cells using Col1a1‐Cre; Slc26a2 fl/fl mouse line recapitulates a similar but worsened vertebral phenotype featured by lamellar isthmus. In addition, when reaching late adulthood, D673V homozygotes develop an evident bone‐loss phenotype and show impaired osteogenesis. These findings support a multifactorial etiology, involving congenitally predisposed isthmic conditions, altered biomechanics, and age‐dependent bone loss, which leads to SLC26A2‐related spondylolysis.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Phenotypic characterization of Slc26a2 mutant mice reveals a multifactorial etiology of spondylolysis

et al. 2019

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“…It has also been reported that patients with spondylolysis have a smaller caudal increase in the lumbar transverse interfacet distance compared with healthy individuals. 45,48 Therefore, in the present study, radiographic findings included the presence of SBO, the LL angle, and the L1:L5 ratio.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Spondylolysis on Magnetic Resonance Imaging in Adolescent Athletes With Low Back Pain

Yokoe

Tajima

Sugimura

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Spondylolysis and undiagnosed mechanical low back pain (UMLBP) are the main causes of low back pain (LBP) in adolescent athletes. No studies have evaluated the difference in clinical and radiographic factors between these 2 conditions. Furthermore, it remains unclear which adolescent athletes with LBP should undergo advanced imaging examination for spondylolysis. Purpose: To compare the clinical and radiographic factors of adolescent athletes with spondylolysis and UMLBP who did not have neurological symptoms or findings before magnetic resonance imaging (MRI) evaluation and to determine the predictors of spondylolysis findings on MRI. Study Design: Cohort study, Level of evidence, 3. Methods: The study population included 122 adolescent athletes aged 11 to 18 years who had LBP without neurological symptoms or findings and who underwent MRI. Of these participants, 75 were ultimately diagnosed with spondylolysis, and 47 were diagnosed with UMLBP. Clinical factors and the following radiographic parameters were compared between the 2 groups: spina bifida occulta, lumbar lordosis (LL) angle, and the ratio of the interfacet distance of L1 to that of L5 (L1:L5 ratio, %). A logistic regression analysis was performed to evaluate independent predictors of spondylolysis on MRI scans. Results: Significantly more athletes with spondylolysis were male (82.7% vs 48.9%; P < .001), had a greater LL angle (22.8° ± 8.1° vs 19.3° ± 8.5°; P = .02), and had a higher L1:L5 ratio (67.4% ± 6.3% vs 63.4% ± 6.6%; P = .001) versus athletes with UMLBP. A multivariate analysis revealed that male sex (odds ratio [OR], 4.66; P < .001) and an L1:L5 ratio of >65% (OR, 3.48; P = .003) were independent predictors of positive findings of spondylolysis on MRI scans. Conclusion: The study findings indicated that sex and the L1:L5 ratio are important indicators for whether to perform MRI as an advanced imaging examination for adolescent athletes with LBP who have no neurological symptoms and findings.

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“…Several reports have described the morphology of the facet joint in spondylolysis. Previous studies that used radiographic images reported that in patients with spondylolysis, the distance of the facet joint in the lower lumbar was reduced 9,10) . This shows an increased load on the pars interarticularis.…”

Section: Discussionmentioning

confidence: 99%

Does facet joint morphology affect the development of spondylolysis?

Ishitani

2020

J Phys Ther Sci

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[Purpose] This study aimed to clarify the contribution of the morphology of the facet joint in spondylolysis. [Participants and Methods] A total of 68 junior athletes with lower back pain were evaluated. They were classified into groups B (bilateral spondylolysis), U (unilateral spondylolysis), and C (without spondylolysis). The same observer measured the sagittal orientation of the L4/L5 and L5/S1 facet joint angles from the axial sections, using computed tomography. Facet joint angles were statistically compared for differences among groups B, UL (the spondylolysis side in group U), UN (the normal side in group U), and C. [Results] The L4/L5 facet joint angles were significantly more coronally oriented in groups B and UL than in group C, while the L5/S1 facet joint angles showed no significant differences among the four groups. [Conclusion] The results of this study suggest that a more coronal orientation of the L4/L5 facet joint may increase the point loading through the L5 pars interarticularis in extension and rotation. Therefore, if the L4/L5 facet joint is more coronally orientated, the patient may be at the risk of spondylolysis. This observation may aid in predicting patients with increased possibility of developing spondylolysis.

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Radiographic Assessment of Lumbar Facet Distance Spacing and Pediatric Spondylolysis

Cited by 13 publications

References 11 publications

Phenotypic characterization of Slc26a2 mutant mice reveals a multifactorial etiology of spondylolysis

Phenotypic characterization of Slc26a2 mutant mice reveals a multifactorial etiology of spondylolysis

Predictors of Spondylolysis on Magnetic Resonance Imaging in Adolescent Athletes With Low Back Pain

Does facet joint morphology affect the development of spondylolysis?

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