Union evaluation of lumbar spondylolysis using MRI and CT in adolescents treated conservatively

Tatsumura, Masaki; Gamada, Hisanori; Okuwaki, Shun; Eto, Fumihiko; Nagashima, Katsuya; Iwabuchi, Sho; Ogawa, Tomoya; Mammoto, Takeo; Hirano, Atsushi; Yamazaki, Masashi

doi:10.1016/j.jos.2021.01.002

Cited by 14 publications

(27 citation statements)

References 12 publications

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“…Males with lumbar spondylolysis with bone marrow edema constituted 79.6% of the subject population in our previous report [2]. The recurrence rate for males was 18/125 (14.4%) and for females was 2/27 (7%).…”

Section: Discussionmentioning

confidence: 71%

Characteristics of Recurrent Cases after Conservative Therapy in Adolescent Lumbar Spondylolysis

Tatsumura

Gamada

Okuwaki

et al. 2021

Preprint

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Purpose: Occasionally lumbar spondylolysis in adolescents will recur after conservative treatment. The goal of this study was to retrospectively review the conditions in which recurrence transpired in a subset of adolescent patients diagnosed with acute lumbar spondylolysis. Subjects: A retrospective survey was conducted in 152 patients who had been treated for spondylolysis and had obtained bone union. Twenty subjects were selected who had recurrent lumbar spondylolysis after returning to sports activity following the first spondylolysis treatment. There were 18 males and two females with an average age at the time of initial consultation of 13.3 years and 14.1 years at the time of recurrence.Results: The average period of initial treatment was 101 days, and the average time to recurrence after healing was 149 days. There were three cases at L3, two cases at L4 and 15 cases at L5. At recurrence, 18 patients had unilateral involvement and two patients presented with bilateral occurrence. Four cases did not achieve bony union.Discussion: In this study, the recurrence rate was 13.2%. Eighty percent of cases had recurrence within six months after healing. After recurrence, 20% of the cases reached pseudoarthrosis. It is useful to take regular MRI images to detect recurrence within six months after returning to sports.

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Section: Discussionmentioning

confidence: 71%

Characteristics of Recurrent Cases after Conservative Therapy in Adolescent Lumbar Spondylolysis

Tatsumura

Gamada

Okuwaki

et al. 2021

Preprint

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“…In the treatment of lumbar spondylolysis, there are many reports on conservative treatment for early return to sports and the use of low-intensity pulsed ultrasound to improve the rate of bone union [10][11]. However, the rate of bone union with conservative treatment is 76-94%, and there is still a risk of prolonged pain if bone union is not achieved [9,[12][13].…”

Section: Discussionmentioning

confidence: 99%

“…The patient was diagnosed as right L5, pre-lysis-stage lumbar spondylolysis. Conservative treatment such as wearing a hard Knight-type plastic brace, stopping training, and physical therapy was started [9]. After 3 months of conservative treatment, the signal change on MRI disappeared, and bone union was achieved with no obvious worsening of the fracture on CT (Figure 3).…”

Section: Figure 2: Computed Tomography At First Examinationmentioning

confidence: 99%

Minimally Invasive Screw Fixation of Non-Pseudoarthorotic Lumbar Spondylolysis for Early Return to Sports

Gamada

Tatsumura

Okuwaki

et al. 2021

Cureus

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Lumbar spondylolysis is a fatigue fracture that occurs most frequently in middle and high school athletes. Conservative treatment is the first choice when the fracture is fresh. Surgical treatment of lumbar spondylolysis is often reported for pseudarthrosis cases, but surgery for cases of fresh fractures is rare. We report a case of a 16-year-old male, high jump athlete, with recurrent non-pseudoarthorotic lumbar spondylolysis.He presented to our hospital with a chief complaint of back pain, and was diagnosed as right L5, pre-lysisstage lumbar spondylolysis. After 3 months of conservative treatment, bone union was achieved with no obvious worsening of the fracture. His back pain also disappeared and he was able to return to exercise. At 6 months after the first examination, the lesion recurred and he could no longer continue playing sports, so surgical treatment was indicated.Minimally invasive screw fixation was performed by combining Buck's method and the cortical bone trajectory. After the surgery, he started jogging at 5 weeks, resumed jumping practice at 7 weeks, and returned to competition at 2 months. He set a new personal best in a competition 3 months post-surgery. Bone union was achieved at 4 months. This technique is minimally invasive and does not involve debridement or bone grafting, which provides early pain relief and return to sports.

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“…Clinical observation found that new onset spondylolysis may be cured by restricting lumbar spine movement with a brace[ 2 , 5 , 9 , 10 ]. A retrospective study showed that a union rate of conservative treatment in adolescents was 76%[ 11 ]. However, about 90% of end-stage L5 spondylolysis patients are first diagnosed in adulthood.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of four segment lumbar spondylolysis: A case report

Li¹,

Peng²

2021

WJCC

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BACKGROUND Four-level lumbar spondylolysis is extremely rare. So far, only 1 case has been reported in the literature. CASE SUMMARY A 19-year-old man presented with severe back pain irresponsive to conservative therapies for 2 years. Lumbar radiographs and two-dimensional computed tomography scan showed four segment lumbar spondylolysis on both sides of L2-L5. Lumbar magnetic resonance imaging showed normal signal in all lumbar discs. Because daily activities were severely limited, surgery was recommended for the case. The patient underwent four-level bilateral isthmic repair at L2-L5. During surgery, L2-L5 isthmi were curetted bilaterally, freshened, and then grafted with autologous iliac bone that was bridged and compressed with a pedicular screw connected to a sub-laminar hook by a short rod. The symptoms of back pain almost disappeared. He has been followed-up for 96 mo, and his symptoms have never recurred. Fusion was found in all repaired isthmi 14 mo after surgery according to evaluation of lumbar radiography and computed tomography scan. CONCLUSION We report here 1 case of four-level lumbar spondylolysis that was treated successfully with direct isthmic repair.

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Union evaluation of lumbar spondylolysis using MRI and CT in adolescents treated conservatively

Cited by 14 publications

References 12 publications

Characteristics of Recurrent Cases after Conservative Therapy in Adolescent Lumbar Spondylolysis

Characteristics of Recurrent Cases after Conservative Therapy in Adolescent Lumbar Spondylolysis

Minimally Invasive Screw Fixation of Non-Pseudoarthorotic Lumbar Spondylolysis for Early Return to Sports

Surgical treatment of four segment lumbar spondylolysis: A case report

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