Unilateral Spondylolysis and Contralateral Pedicle Fracture

Garber, John E.; Wright, A.M.

doi:10.1097/00007632-198601000-00018

Cited by 50 publications

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“…These fractures may occur bilaterally or on the contralateral side in patients with unilateral spondylolysis [1,2,6,7,12]. Bilateral pedicle fracture is a rare entity.…”

Section: Discussionmentioning

confidence: 99%

Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture

et al. 2008

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A case of bilateral pedicle stress fracture of L4 in a patient with osteoporotic compression fracture of L5 and without a history of major trauma or surgery is reported, and the literature is reviewed. Bilateral pedicle fracture is a rare entity and few cases have been reported in the literature. All reported cases had some underlying causative factors like previous spine surgery or stress related activities. To the best of the authors' knowledge, only one case of bilateral pedicle stress fracture without a history of trauma, previous spine surgery, or stress-related activities has been reported. A 77-year-old woman presented with severe low back pain and radiating pain in the right leg that was exacerbated after standing and walking. Plain radiograph showed pathological fracture at L5 level. Magnetic resonance imaging (MRI) revealed the compression of dural sac at L5 level. CT scan taken 3 months after admission revealed bilateral pedicle fractures through L4. The patient was treated with decompressive laminectomies of L4, followed by posterior spinal fusion with rigid pedicle screw fixation and autogenous bone graft mixed with hydroxyapatite. The patient achieved pain relief and returned to normal activity. Stress fracture of the pedicle within the proximal vertebra of an osteoporotic compression fracture of lumbar spine is an uncommon entity. It may, however, be an additional source of symptoms in patients with osteoporosis who present with further back pain. Surgeons caring for this group of patients should be aware of this condition.

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“…These fractures may occur bilaterally or on the contralateral side in patients with unilateral spondylolysis [1,2,6,7,12]. Bilateral pedicle fracture is a rare entity.…”

Section: Discussionmentioning

confidence: 99%

Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture

et al. 2008

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“…Unilateral spondylolysis associated with sclerosis and hypertrophy of the contralateral side of the neural arch is well described in the literature [1][2][3][4][5][6][7][8]10]. Pedicle fractures also occurred following contralateral isthmic spondylolysis, secondary to a weakening of the neural arch with resulting increased stress across the contralateral pedicle [1,2,4].…”

Section: Discussionmentioning

confidence: 99%

“…Pedicle fractures also occurred following contralateral isthmic spondylolysis, secondary to a weakening of the neural arch with resulting increased stress across the contralateral pedicle [1,2,4]. Unilateral spondylolysis associated with pedicular fracture has been described in competitive sport patients [2,5,10].…”

Section: Discussionmentioning

confidence: 99%

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Acute L5 pedicle fracture and contralateral spondylolysis in a 12-year-old boy: a case report

Vialle¹,

Mary²,

Carvalho³

et al. 2007

Eur Spine J

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Acute unilateral L5 pedicle fracture associated with a pre-existing contralateral spondylolysis is a rare lesion. We report a case in a non-competitive 12-year-old boy. We present the clinical, radiological and specific management of this rare condition. The clinical and radiological draft of this patient was reviewed. The followup was 30 months after fracture healing. Some cases reported in the literature were analyzed and our clinical findings and therapeutic strategy was compared and discussed. Non-operative treatment was done including fulltime bracing in a modified Boston brace incorporating one thigh for 3 months. Plain radiographs and computed tomographic (CT)-scan performed at 3 and 6 months showed progressive healing of the pedicle fracture and no modification of the contralateral isthmic spondylolytic lesion. At final follow-up, the patient was asymptomatic and resumed all his activities. In skeletally immature patients, we think that conservative treatment should be considered as a treatment option for this unusual injury.

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“…Oblique radiography and CT are sensitive in detecting a cleft in the lamina. An MR imaging feature of the retroisthmic cleft has been reported in a few case reports, showing as a linear high-signal lesion on T2-weighted images [48]. The natural course is not well understood.…”

Section: Retroisthmic Cleftmentioning

confidence: 98%

Spondylolytic spondylolisthesis: various imaging features and natural courses

Nakayama

Ehara

2014

Jpn J Radiol

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with spondylolysis and the other with degeneration of facet joints and/or intervertebral disc. Many patients with spondylolysis remain asymptomatic and certain cases become symptomatic, with low back pain and, less commonly, radicular pain. Spondylolisthesis can also be asymptomatic, but may cause low back pain, spinal instability, and radiculopathy, which requires conservative and/or surgical treatment.The incidence of lumbar spondylolysis has been reported to be 8 % in the adult population [2], and it was variable among races and sexes. Sakai et al. [3] reported that the prevalence of lumbar spondylolysis among the Japanese population between 20 and 29 years of age, found by multidetector CT, was 5.9 %, with a male to female ratio of 2:1. Spondylolysis has never been seen in newborn babies: it is seen only after walking. The upright posture and bipedal position play a role in the development of spondylolysis [4]. The prevalence of lumbar spondylolisthesis was reported to be 20.7 % in the adult population, and spondylolysis without spondylolisthesis was relatively uncommon and was only seen at the lower lumbar level [5].Although bone defects of typical isthmic spondylolysis run obliquely through the pars interarticularis, and are well depicted on oblique lumbar radiography, atypical isthmic defects have been reported in several papers [6,7]. The pathomechanism and incidence of atypical isthmic defects is not well known, and the radiographic appearance of atypical isthmic spondylolysis has not been well recognized among radiologists. Other atypical spondylolyses included various types, and two variations have been reported in the literature [8][9][10]. Unilateral spondylolysis accounts for 3-33 % of all cases of spondylolysis and has been estimated to be approximately 3-7 % of the general population [11]. It may be associated with certain athletic activities, such as cricket, ballet, and gymnastics, and the association with Abstract The purpose of this paper is to review typical and atypical imaging features of spondylolytic spondyolisthesis and natural courses. Imaging features of the typical pars defect in early phase include bone marrow edema of the isthmus on MR imaging with progression of bone defect on plain radiography or CT. There are various defect types (pedicular cleft, retroisthmic cleft) and locations (upper lumbar spine and unilateral lesions). Natural courses also vary, with different patterns of progression and stabilization. Clinical correlation of the imaging and clinical features is often difficult.

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Unilateral Spondylolysis and Contralateral Pedicle Fracture

Cited by 50 publications

References 0 publications

Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture

Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture

Acute L5 pedicle fracture and contralateral spondylolysis in a 12-year-old boy: a case report

Spondylolytic spondylolisthesis: various imaging features and natural courses

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