Spondylolysis and spondylolisthesis: A cost of being an erect biped or a clever adaptation?

Sex-Based Differences in Age-Related Changes of the Vertebral Column from a Bronze Age Urban Population in Ancient China

The health disparities between males and females in bioarchaeological settings are important indicators of gender-based differences in socioeconomic roles. In this study, sex-based differences of the vertebral column in spine pathology were investigated in human skeletons excavated from a Bronze Age cemetery of the Western Zhou Dynasty at the Dahekou site in Shanxi, China. Results demonstrated that females had a higher prevalence of vertebral compressive fractures, with the majority found in those between twenty-five and thirty years old, suggesting that the fractures were a consequence of osteoporosis and its early onset in females. In contrast, males expressed overall more severe ageing in all vertebral divisions compared to females. Males also had a higher prevalence of vertebral facet joint osteoarthritis in cervical and thoracic divisions than females. Likewise, the incidence of facet joint osteoarthritis was more asymmetric between the left and right joints in males than in females. These findings reflect disparities of vertebral health between the two sexes in an urban setting, in which ageing and injuries of the vertebral column might be driven by different mechanisms. Age-related changes in female vertebral columns may have been more influenced by conditions of hormone deficiency such as menopause, while male vertebral columns might have been more prone to age-related changes due to heavy labor-induced physical stressors. Further studies on the differentiation of ageing mechanisms between the two sexes based on physiology, socioeconomic roles, and living conditions are warranted. The studies are necessary in understanding how multiple sociocultural and physiological factors contribute to health disparities in historic and contemporary environments.

Spondylolysis in the past: A case study of hunter-gatherers from Southern Patagonia

Spondylolysis is a fracture of the pars interarticularis, the portion of the neural arch that lies between the superior articular facets and the inferior articular facets. Clinical evidence has suggested repetitive trauma to be the most probable cause, even though morphological weakness of the vertebra is probably also involved. Prevalence is between 3% and 8% in modern populations, while in archaeological samples it varies from 0% to 71.4%. Considering that very little data about this condition is available in past populations from the southern extreme of South America, the aim of this paper is to analyze the spondylolysis in a human skeletal sample from Southern Patagonia and, at the same time, to explore the prevalence of spondylolysis in archaeological contexts around the world to gain a better understanding of the results presented here. The Southern Patagonian skeletal series analyzed here showed a prevalence of 20%, with lower prevalence in the pre contact sample (11.1%) than in the contact period (23.1%). Skeletons from the Salesian Mission "Nuestra Señora de La Candelaria" showed a higher prevalence (25%) than the sample of skeletal remains recovered from outside the mission (20%), suggesting that changes in lifestyle of hunter-gatherers during contact could be implicated in the development of spondylolysis in this sample. A worldwide survey displays a wide range of prevalence figures in American and Asian samples and low diversity between African and European populations. Hunter-gatherers from Southern Patagonia showed similar values to those observed in other American samples.

Post-Cranial Traumatic Injury Patterns in Two Medieval Polish Populations: The Effects of Lifestyle Differences

Traumatic injuries can be used as general indicators of activity patterns in past populations. This study tests the hypothesis that contemporaneous (10th-12th century) rural and urban populations in medieval Poland will have a significantly different prevalence of non-violent fractures. Traumatic injuries to the post-cranial skeleton were recorded for 180 adults from rural Giecz and for 96 adults from urban Poznań-Śródka. They were statistically analyzed by body region and individual skeletal element. Results reveal that Giecz had a significantly higher rate of trunk fractures than Poznań-Śródka (Fisher's exact, p<0.05). In particular, rib and vertebral fractures were more common in Giecz males and females than in their Poznań-Śródka counterparts. Traumatic injuries in the extremities were comparable between the two samples, suggesting similar risks of trauma to these regions. These results indicate that in early medieval Poland, activities associated with a rural lifestyle resulted in more injuries. These stress or accidental fractures, which are related to a high-risk setting, were not consistent with an urban lifestyle. Overall, agricultural populations like Giecz were engaged in a laborious lifestyle, reflected in a variety of injuries related to repetitive, high-risk activities. Although urban populations like Poznań engaged in craft specialization participated in repetitive activities, their lifestyle resulted in lesser fracture-risk.

Lumbar vertebral morphology and isthmic spondylolysis in a British medieval population

The British medieval population from Wharram Percy, England, has a greater prevalence of isthmic spondylolysis (11.9% of skeletons, 8.5% at the L5 level) than in modern populations (3%-6%). This may in part be due to differences in activity patterns between groups. However, Ward and Latimer (Spine 30 [2005] 1808-1814) proposed that the likelihood of developing and maintaining spondylolytic defects is also influenced by a lack of sufficient increase in mediolateral separation between articular processes in the lowest lumbar segments, given the human lumbar lordosis. Here, we demonstrate that spondylolytic individuals from Wharram Percy tend to have a less pronounced difference between mediolateral facet joint spacing of adjacent segments in the lowest lumbar region than do unaffected individuals, as seen in modern clinical and skeletal populations. These comparisons suggest that regardless of lifestyle, insufficient mediolateral increase in facet spacing predisposes people to spondylolytic defects, and so interfacet spacing patterns may have predictive utility in a clinical context. We also compare the Wharram Percy sample to a modern sample from the Hamann Todd collection with a typically modern prevalence rate. Data do not support the hypothesis that the Wharram Percy individuals had a less pronounced interfacet increase than the Hamann Todd, although they do have narrower lumbar facet spacing at the lowest three levels. Further investigation of anatomical variation underlying population-specific prevalence rates needs to be conducted.

Sacral orientation and spondylolysis

STUDY DESIGN

A descriptive study (based on skeletal material) was designed to measure sacral anatomic orientation (SAO) in individuals with and without spondylolysis.

OBJECTIVE

To test whether a relationship between SAO and spondylolysis exists.

SUMMARY OF BACKGROUND DATA

Spondylolysis is a stress fracture in the pars interarticularis (mainly of L5). The natural history of the phenomenon has been debated for years with opinions divided, i.e., is it a developmental condition or a stress fracture phenomenon. There is some evidence to suggest that sacral orientation can be a "key player" in revealing the etiology of spondylolysis.

METHODS

The pelvis was anatomically reconstructed and SAO was measured as the angle created between the intersection of a line running parallel to the superior surface of the sacrum and a line running between the anterior superior iliac spine (ASIS) and the anterior-superior edge of the symphysis pubis (PUBIS).SAO was measured in 99 adult males with spondylolysis and 125 adult males without spondylolysis. The difference between the groups was tested using an unpaired t test.

RESULTS

Spondylolysis prevalence is significantly higher in African-Americans compared to European-Americans: 5.4% versus 2.04% in males (P < 0.001) and 2.31% versus 0.4%, P < 0.001 in females. SAO was significantly lower in the spondylolytic group (44.07 degrees +/- 11.46 degrees) compared to the control group (51.07 degrees +/- 8.46 degrees, P < 0.001).

CONCLUSION

A more horizontally oriented sacrum leads to direct impingement on L5 pars interarticularis by both L4 inferior articular facet superiorly and S1 superior articular facet inferiorly. Repetitive stress due to standing (daily activities) or sitting increases the "pincer effect" on this area, and eventually may lead to incomplete synostosis of the neural arch.

Radiographic assessment of lumbar facet distance spacing and spondylolysis

STUDY DESIGN

Spondylolytic defects at L5 are influenced by insufficient differential spacing between the inferior articular facets of L4 and superior facets of S1. These structures then impinge on the intervening L5 pars interarticularis during hyperlordosis, contributing to fracture and resorption of the pars.

OBJECTIVES

Articular facet spacing was evaluated on clinical radiographs of normal and spondylolytic patients.

SUMMARY OF BACKGROUND DATA

Spondylolysis ranges from a hairline fracture through the pars to a complete pseudarthrotic defect. Insufficient increase in the distance between articular facets from L4-L5 to L5-S1 has been associated with chronic lytic defects in a skeletal sample.

METHODS

Anteroposterior radiographs of 39 patients with L5-S1 spondylolysis were compared with radiographs from 42 normal individuals. Differences in transverse distances between lumbar articular facets and pedicles were compared using 2-tailed t tests.

RESULTS

Patients with spondylolysis exhibited a smaller increase in interfacet distance from the L3-L4 facet joints to the L5-S1 joints than do normal patients, even relative to vertebral size.

CONCLUSIONS

Spondylolytic fractures at L5 are influenced by an inadequate increase in interfacet distances between adjacent vertebrae. Individuals lacking sufficient increase in lower lumbar transverse interfacet dimensions are at greater risk of developing and maintaining spondylolytic defects.

Spondylolysis, spondylolisthesis, and lumbo-sacral morphology in a medieval English skeletal population

The prevalence of spondylolysis and spondylolisthesis was studied in an adult skeletal series from a rural English medieval archaeological site. Attempts were made to evaluate the association of three aspects of lumbo-sacral skeletal morphology (pelvic incidence (a measure of the anterior inclination of the sacral table), lumbar transverse process width, and the presence of lumbo-sacral spina bifida occulta) with spondylolysis and spondylolisthesis. Results indicated a high prevalence of spondylolysis compared with a modern reference population, but few cases of spondylolisthesis were identified. Analysis of prevalence with respect to age suggests that in the study population, pars interarticularis defects generally formed late in the growth period or early in adult life. The study group showed a high mean pelvic incidence compared with modern Western Europeans, indicating a more steeply inclined sacral table, which may have elevated the risk of developing pars interarticularis defects. However, no statistically valid association could be demonstrated between the presence/absence of spondylolysis and pelvic incidence in the study material. There was no evidence for a link between lumbar transverse process index or lumbo-sacral spina bifida occulta and spondylolysis/spondylolisthesis. It is concluded that the potential role of lumbo-sacral morphology, as well as of activity regimes, should be considered when interpreting spondylolysis in paleopathological studies. If the frequency of spondylolysis is to some extent an indicator of past activity regimes, it may reflect lifestyle in younger individuals rather than in mature adults. Further work investigating the link between spondylolysis and lumbo-sacral morphological variables in premodern populations would be of value.

Human evolution and the development of spondylolysis

STUDY DESIGN

We propose that chronic spondylolytic defects at L5 are influenced by insufficient differential mediolateral distances between inferior articular facets of L4 and the superior facets of S1, which results in these structures impinging on adjacent sides of the par interarticularis during hyperlordosis. Individuals with adequate increase in interfacet distances from L4 through S1 are less likely to develop or maintain defects.

OBJECTIVES

We test the above hypothesis by comparing the transverse interfacet dimensions throughout the lumbar columns of normal and spondylolytic individuals.

SUMMARY OF BACKGROUND DATA

Spondylolysis is a common condition, yet its etiology is poorly understood. It is generally considered to be the result of a vaguely defined fatigue fracture through the pars interarticularis. The cause(s) of spondylolysis, however, have not been clearly identified.

METHODS

Lumbar vertebrae from the Hamann-Todd osteological collection at the Cleveland Museum of Natural History were examined. Thirty individuals with bilateral spondylolysis at L5 were compared with 30 age- and sex-matched controls. Differences in transverse distances between articular facets and in transverse breadths of vertebral bodies were compared using two-tailed t tests.

RESULTS

Results show that normal individuals have a significantly greater increase in interfacet dimensions progressing down the spine from L4 to S1 than do those with spondylolysis. These differences are not the result of normal individuals having increasingly large vertebrae, as results are significant even when standardized for vertebral body breadth. Vertebral body size itself does not differ systematically between groups.

CONCLUSIONS

Spondylolysis is the direct result of contact pressures on both sides of the pars interarticularis resulting from inadequate separation between the inferior articular processes of L4 and the superior articular facets of S1. Individuals lacking sufficient increase in transverse interfacet dimensions in their lumbar columns are at greater risk of developing and maintaining spondylolytic defects.

Asymmetrical spondylolysis

The objective of this study was to examine examples of spondylolysis in which the pattern of separation was clearly asymmetrical, in order to learn more about the process of bone separation that produces this condition. Although the primary focus was on unilateral complete separation, examples of asymmetry represented by incomplete separation and by complete bilateral separation where the separation sites are in different locations on the two sides were included. Two collections were used, one consisting of Canadian Inuit skeletons curated at the Canadian Museum of Civilization, and the other of 48 individual examples of asymmetrical spondylolysis from sites in a variety of localities curated by several different institutions. The first collection was studied primarily to observe early manifestations of spondylolysis, particularly incomplete separation, while various patterns of asymmetrical complete separation were the focus of the second. The results indicate that asymmetry is part of the earliest osteological picture of spondylolysis, with right-sidedness predominating, a condition perhaps related in some way to handedness. The right-side predominance appears to decrease with age. The ratio of unilateral to bilateral separation ranges from 3-33% in different studies, and a significant number of the unilateral separations have spina bifida occurring in the same vertebra. Overall, the specimens examined here, considered along with clinical cases, nicely illustrate a progression of spondylolysis. A unilateral separation may heal, it may progress to bilateral separation, or it may remain as a permanent condition, producing a pattern of degenerative changes that can include spondylolisthesis. A unilateral healing of bilateral complete separation is likely a rare phenomenon, at least after the separations have reached a certain level of maturity.

Degenerative spondylolisthesis in ancient and historic skeletons from New Mexico Pueblo sites

The objective of this study was to identify the presence of degenerative spondylolisthesis in adult Native American skeletons recovered from prehistoric and historic Pueblo sites in New Mexico. The vertebral columns of 491 individuals that were complete enough to allow the necessary observations produced 64 cases, with a total of 74 affected levels. The L5-S1 level was affected most frequently (78%), in contrast to clinical and anatomical studies where the L4-L5 level was usually affected (80%). Age and sex were found to be important factors, with the condition limited to middle and old adults, and occurring in females over males at a ratio of approximately 5:1. Olisthesis was shown to occur only in association with severe osteoarthritis of the zygapophysial joints, but severe osteoarthritis did not always result in olisthesis, particularly in males. Parallel or convergent inferior articular processes were found to increase in frequency in the presence of olisthesis, apparently resulting from degenerative remodeling that produced the olisthesis. The data also suggest that individuals with cranial border shifting in the column may be especially prone to olisthesis. Degenerative olisthesis was also observed in the cervical region.

Vertebral age changes in Japanese macaques

This study deals with maturation and aging of the vertebrae in Japanese macaques (Macaca fuscata fuscata) of known chronological age. The samples used were 103 skeletons of captive raised Japanese macaques varying in age from 6-23 years. Epiphyseal union between the vertebral body and the epiphyseal disk (epiphyseal ring, annular epiphysis) and degenerative changes of the vertebrae were macroscopically examined. It was revealed that vertebral epiphyseal union develops comparatively rapidly in the sacral and cervical vertebrae, moderately in the lumbar vertebrae, and slowly in the thoracic vertebrae. It was found that, as a central tendency, the vertebral epiphyseal union begins at about 6 years of age, progresses lineally in proportion to age, and completes at about 23 years of age. However, considerable variation in developmental states of union was observed among individuals of the same age. Concerning vertebral degenerative changes, few were observed among the present samples. Compared with the other primates with regard to the timing of vertebral maturation, shortening of duration of maturation was found among humans. Human vertebrae may have become an early-maturing organ in order to sustain the increased loading that is accompanied by the adoption of habitual erect posture and bipedal locomotion.

Spondylolysis in prehistoric human remains from Guam and its possible etiology

This study reports the findings of complete bilateral separation of the neural arch (spondylolysis) in 176 inhumations from the Hyatt Site, Tumon Bay, which is located on the west side of the island of Guam. Skeletons were excavated and analyzed by the Paul H. Rosendahl Inc. (PHRI) team in 1989-1990. The inhumations were associated with the pre-European Latte Period (circa 1,200-1,521 A.D.). This period was characterized by the use of large stone pillars, called latte sets, for the construction of houses. Of the 176 individuals, only 38 adult skeletons had complete spines, and 21% (8/38) of these had evidence of spondylolysis in their lumbar vertebrae, particularly in L-5. The age of the eight individuals range from 30 to 50 years. No children were found with spondylolysis. Of the males 29.4% (5/17) had spondylolysis, as did 14.3% (3/21) of the females. However, the difference between the sexes was not statistically significant. Though the sample is small, it is suggested that the high incidence of lumbar spondylolysis found in these ancient Chamorros was related to lower back traumatic events. The transport of latte stones, involving hyperextension and torque of the lower back, while dragging the stones, probably contributed to the development of microfractures in the spine and subsequent spondylolysis. If this hypothesis is correct, then both males and females appear to have been participants in an organized community labor force. It is predicted that similar frequencies of spondylolysis will be found at other Latte sites.