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Yagi K, Kishima K, Tezuka F, Morimoto M, Yamashita K, Takata Y, Sakai T, Maeda T, Fujitani J, Sairyo K. A Technical Pitfall of Decompression with Direct Repair of a Ragged Edge Using the Smiley-Face Rod Method : A Case Report. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:308-311. [PMID: 36244786 DOI: 10.2152/jmi.69.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The smiley-face rod method has been reported to be a successful technique for reducing slippage and repairing pars defects in lumbar spondylolisthesis. However, we encountered a patient who developed right L5 radiculopathy with muscle weakness after use of the smiley-face rod method. The patient was a 19-year-old female judo player who had undergone direct repair surgery using the smiley-face rod method for terminal-stage lumbar spondylolysis. Postoperatively, she developed paresthesia on the lateral side of the right thigh with weakness of the right tibialis anterior and extensor hallucis longus. Computed tomography showed right foraminal stenosis at L5 with the floating lamina shifted ventrally and apophyseal ring fracture. In this case, the spondylolysis fracture angle differed between the left and right sides, with the fracture line on the right side running more sagittally. As a result, the floating lamina was shifted ventrally on the right side by compression and the right L5 intervertebral foraminal space was narrowed due to the ventral shift in the floating lamina and the apophyseal ring bone fragment. The shape of the fracture line should be examined carefully before surgery to avoid this technical pitfall. J. Med. Invest. 69 : 308-311, August, 2022.
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Affiliation(s)
- Kiyoshi Yagi
- Department of Orthopedics, Tokushima University, Tokushima, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Kazuya Kishima
- Department of Orthopedics, Tokushima University, Tokushima, Japan
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | | | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Anan Medical Center, Tokushima, Japan
| | - Junzo Fujitani
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Japan
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Yokoe T, Tajima T, Sugimura H, Kubo S, Nozaki S, Yamaguchi N, Morita Y, Chosa E. Predictors of Spondylolysis on Magnetic Resonance Imaging in Adolescent Athletes With Low Back Pain. Orthop J Sports Med 2021; 9:2325967121995466. [PMID: 33889645 PMCID: PMC8040580 DOI: 10.1177/2325967121995466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022] Open
Abstract
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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Affiliation(s)
- Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
- Takuji Yokoe, MD, Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan ()
| | - Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Hiroshi Sugimura
- Department of Radiology, Nozaki Higashi Hospital, Murasumi, Miyazaki, Japan
| | - Shinichirou Kubo
- Department of Orthopaedic Surgery, Nozaki Higashi Hospital, Murasumi, Miyazaki, Japan
| | - Shotarou Nozaki
- Department of Orthopaedic Surgery, Nozaki Higashi Hospital, Murasumi, Miyazaki, Japan
| | - Nami Yamaguchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Yudai Morita
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
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Okuwaki S, Tatsumura M, Gamada H, Ogawa T, Mammoto T, Hirano A, Yamazaki M. Direct reduction and repair of spondylolysis with grade 1 slip using the smiley face rod: a case report. J Rural Med 2021; 16:56-61. [PMID: 33442437 PMCID: PMC7788300 DOI: 10.2185/jrm.2020-039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
Objective: Lumbar spondylolysis, caused by stress fracture of the pars
interarticularis may lead to a bony defect or spondylolisthesis. In adolescents, its
surgical treatment employs the smiley face rod method for direct reduction of
pseudoarthrotic spondylolysis and spondylolisthesis. Clinical outcomes of this treatment
have been occasionally described; however, implant removal has not been discussed
previously. We present a patient with lumbar spondylolysis with grade 1 slip at the 5th
lumbar vertebra (L5) per the Meyerding classification. Patient: A 14-year-old boy presented with chronic severe lower back pain.
Since conservative therapy did not resolve pain or enable resuming sports activities, the
smiley face rod repair was performed 7 months after the initial treatment. Result: Anterior slippage of the L5 was surgically reduced. The patient wore
a brace for 3 months postoperatively, and partial bone fusion was noted 6 months
postoperatively. He resumed his sports activity 8 months postoperatively, and absolute
bone fusion was confirmed 18 months postoperatively. Implant removal was performed 3 years
postoperatively. Grade 1 slip was corrected with absolute bone fusion, and long-term
follow-up revealed good results in terms of healing and rehabilitation. Conclusion: Smiley face rod method that allows for implant removal after
bone fusion is suitable for adolescents.
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Affiliation(s)
- Shun Okuwaki
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan
| | - Masaki Tatsumura
- Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan
| | - Hisanori Gamada
- Department of Orthopedics Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Takeshi Ogawa
- Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan
| | - Takeo Mammoto
- Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan
| | - Atsushi Hirano
- Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan
| | - Masashi Yamazaki
- Department of Orthopedics Surgery, Faculty of Medicine, University of Tsukuba, Japan
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Eto F, Tatsumura M, Gamada H, Okuwaki S, Koda M, Yamazaki M. Bone Healing in Adolescents with Bilateral L5 Spondylolysis with and without Preexisting Contralateral Terminal Spondylolysis. Asian Spine J 2020; 15:747-752. [PMID: 33355849 PMCID: PMC8696065 DOI: 10.31616/asj.2020.0309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/15/2020] [Indexed: 12/04/2022] Open
Abstract
Study Design Retrospective cohort study Purpose To examine bone healing with conservative treatment in cases of adolescent bilateral L5 spondylolysis. Overview of Literature We classified bilateral L5 spondylolysis, which is the most affected spinal level, by fracture stage and aimed to compare the bone healing rate according to the fracture stage and evaluate the presence of a preexisting contralateral terminal fracture at the diagnosis of fresh spondylolysis. Methods We evaluated 48 patients (38 boys and 10 girls) with bilateral L5 spondylolysis diagnosed during or before high school. L5 spondylolysis was classified into two groups: fresh group (bilateral fresh spondylolysis cases), and terminal group (cases wherein one side had fresh spondylolysis and the contralateral side had terminal spondylolysis). We investigated the age of examination and bone healing rate in both groups. We investigated progressive-stage lesions and bone healing rate with or without progressive-stage lesions. Results The bone healing rate in the fresh group was significantly higher than that in the terminal group 72.0% vs. 26.1%, p=0.003). In both the groups, the bone healing rate was significantly higher in patients without progressive-stage lesions than in those with progressive-stage lesions. Conclusions Bone healing of progressive-stage fresh spondylolysis was not achieved by conservative treatment when contralateral terminal spondylolysis was present in adolescents with bilateral L5 spondylolysis. Our results suggest that bilateral L5 spondylolysis treatment strategies must be determined based on the combination of the stages present.
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Affiliation(s)
- Fumihiko Eto
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masaki Tatsumura
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan
| | - Hisanori Gamada
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan
| | - Shun Okuwaki
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Tatsumura M, Okuwaki S, Gamada H, Eto F, Nagashima K, Iwabuchi S, Ogawa T, Mammoto T, Hirano A. Characteristics of adolescent lumbar spondylolysis with acute unilateral fatigue fracture and contralateral pseudoarthrosis. J Rural Med 2020; 15:170-177. [PMID: 33033537 PMCID: PMC7530601 DOI: 10.2185/jrm.2020-026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose: This study aimed to examine the characteristics of lumbar
spondylolysis with acute lumbar spondylolysis on one side and pseudoarthrotic
spondylolysis on the other, relative to acute lumbar spondylolysis on one side only. Patients and Methods: Short-tau inversion recovery images obtained through
magnetic resonance imaging were used to diagnose 58 patients with acute lumbar
spondylolysis with bone marrow edema on one side only. A total of 20 patients who had pars
defects on the contralateral side (terminal-stage pseudoarthrotic spondylolysis) were
included in the contralateral pseudoarthrosis group (P group). The remaining 38 patients
with normal images for the contralateral pars interarticularis were included in the
unilateral lesion group, in which the contralateral side was normal (U group). We
investigated the union rate, age, sex, lesion laterality, vertebral level, pathological
stage, and existing spina bifida occulta in both groups. Results: The P group was characterized by a higher proportion of right-side
cases, L5 lesions, more progressed pathological stage, and spina bifida occulta and a
significantly lower union rate than the U group. Conclusion: The union rate in patients with lumbar spondylolysis with acute
lumbar spondylolysis on one side and pseudoarthrotic spondylolysis on the opposite side
was only 15%. We should inform patients with acute unilateral spondylolysis lesions and
contralateral pseudoarthrosis about this poor union rate and urge them to choose their
therapy accordingly.
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Affiliation(s)
- Masaki Tatsumura
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Japan
| | - Shun Okuwaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Hisanori Gamada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Fumihiko Eto
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Japan
| | - Katsuya Nagashima
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Japan
| | - Sho Iwabuchi
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Japan
| | - Takeshi Ogawa
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Japan
| | - Takeo Mammoto
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Japan
| | - Atsushi Hirano
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Japan
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Yokoe T, Tajima T, Sugimura H, Kubo S, Nozaki S, Yamaguchi N, Morita Y, Chosa E. Comparison of symptomatic spondylolysis in young soccer and baseball players. J Orthop Surg Res 2020; 15:378. [PMID: 32883336 PMCID: PMC7469272 DOI: 10.1186/s13018-020-01910-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spondylolysis is the main cause of low back pain (LBP) in young athletes. There are few studies analyzing the difference of spondylolysis among young athletes with different sports activities. The purpose of this study was to compare the clinical factors and distribution of the lesions of spondylolysis on magnetic resonance imaging (MRI) scans in young soccer and baseball players with symptomatic spondylolysis. METHODS The medical records of 267 young athletes aged 7 to 18 years old who underwent MRI to evaluate the cause of LBP between 2017 and 2020 were retrospectively reviewed to identify patients with spondylolysis. Of the young athletes with symptomatic spondylolysis, clinical factors and MRI findings in soccer and baseball players were retrospectively evaluated. The clinical factors were age, sex, interval from onset of LBP to MRI, and side of the dominant leg in the sports field. MRI findings included number, lumbar level, and side of the lesions. RESULTS A total of 33 soccer players (mean age, 15.4 ± 1.4 years) and 49 baseball players (mean age, 15.4 ± 1.6 years) with symptomatic spondylolysis were enrolled. All patients were male. No significant differences were noted in age and the interval from onset of LBP to MRI between the groups. Soccer players had greater numbers of multiple (p < 0.001) and bilateral (p < 0.001) lesions than baseball players. The dominant side of the hand for pitching or batting was correlated with the contralateral-side lesions in baseball players (p = 0.001). CONCLUSIONS The distribution of the lesions of spondylolysis differed in young soccer and baseball players. Pitching or batting with the dominant-side hand would be associated with contralateral-side lesions in baseball players. Sports-specific movements and the side of the dominant leg should be considered when treating young athletes with symptomatic spondylolysis.
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Affiliation(s)
- Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hiroshi Sugimura
- Department of Radiology, Nozaki Higashi Hospital, 2105 Kouso, Murasumi, Miyazaki, 880-0837, Japan
| | - Shinichirou Kubo
- Department of Orthopaedic Surgery, Nozaki Higashi Hospital, 2105 Kouso, Murasumi, Miyazaki, 880-0837, Japan
| | - Shotarou Nozaki
- Department of Orthopaedic Surgery, Nozaki Higashi Hospital, 2105 Kouso, Murasumi, Miyazaki, 880-0837, Japan
| | - Nami Yamaguchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yudai Morita
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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Fujimoto Y, Sakai T, Sairyo K. What Type of Orthosis is Optimal for Conservative Treatment of Lumbar Spondylolysis?: A Biomechanical Analysis. Spine Surg Relat Res 2019; 4:74-80. [PMID: 32039301 PMCID: PMC7002065 DOI: 10.22603/ssrr.2019-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 08/16/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction To analyze the extent to which various types of orthoses can restrict motion of the lumbar spine and provide basic evidence regarding the optimal orthosis for conservative treatment of lumbar spondylolysis (LS), particularly. Although several orthoses have been developed and applied for LS with better outcomes for bony healing, basic data regarding which is optimal are still lacking. Methods Ten healthy voluntary participants were included in this study. Lumbar spine range of motion (ROM) was analyzed using a three-dimensional motion capture system (NEXUS 2.2, Vicon Motion Systems Ltd., UK) under five conditions wearing no orthosis (NB) and four types of lumbar-sacral orthoses (LSO): custom-made hard LSO (HO), soft LSO supported by four aluminum stays and a custom-molded back cast-panel named "Return to Sports" braces (RS), custom-made soft LSO known as Damen type elasticity corset (DC), and off-the-shelf soft LSO. Results HO showed the highest restriction of motion in all directions than the others. Especially, ROM of rotation and side bending were reduced to 58.3% and 63.6% compared with NB, respectively. The other three LSOs showed significantly higher restriction in extension, rotation, and side bending than NB. In flexion and side bending, DC showed significantly higher restriction than NB. Conclusions HO showed high restriction in all directions. RS showed higher restriction in extension than NB and less restriction in flexion and side bending than other custom-made LSOs. DC was the only soft LSO showing higher restriction than NB in flexion.
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Affiliation(s)
- Yosuke Fujimoto
- Fujimoto Prosthesis and Orthosis Supply Co. Ltd., Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Yamashita K, Sugiura K, Manabe H, Ishihama Y, Tezuka F, Takata Y, Sakai T, Maeda T, Sairyo K. Accurate diagnosis of low back pain in adult elite athletes. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:252-257. [DOI: 10.2152/jmi.66.252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kazuta Yamashita
- Department of Orthopedics, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Orthopedics, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Hiroaki Manabe
- Department of Orthopedics, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Yoshihiro Ishihama
- Department of Orthopedics, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
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Thorpe Lowis CG, Xu Z, Zhang M. Visualisation of facet joint recesses of the cadaveric spine: a micro-CT and sheet plastination study. BMJ Open Sport Exerc Med 2018. [PMID: 29527323 PMCID: PMC5841519 DOI: 10.1136/bmjsem-2017-000338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives The size and shape of a joint cavity are the key determinates for the mobility of the joint. The anatomy and configuration of the facet joint (FJ) recesses at different levels of the spine remain unclear and controversial. The aim of this study was to identify the configuration of the FJ recesses in the cervical, thoracic and lumbar spine using a combination of micro-CT and sheet plastination techniques. Methods Of 19 cadavers (9 males, 10 females, age range of 54–89 years), the FJ cavities of 3 spines were injected with contrast filling and scanned with micro-CT, and 16 plastinated spines were prepared as the series of sagittal (9 sets), transverse (5 sets) or coronal (2 sets) sections with a thickness of 2.5 mm and examined under a stereoscopic microscope. Results This study characterised the FJ spaces and recesses of the spine and found that (1) the configuration and extent of the FJ recesses varied along the spine. The optimal needle approach to the FJ cavity was via an anterolateral or posterolateral recess at the cervical level, along the tip of the inferior articular process at the thoracic level and via the posteromedial recess at the lumbar level. (2) The FJ cavity did not communicate with the retrodural space. Conclusion The anatomical features of the FJ recesses at different levels of the spine confirm no direct communication between the FJ cavity and retrodural space.
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Affiliation(s)
| | - Zhaoyang Xu
- Department of Anatomy, Anhui Medical University, Hefei, China
| | - Ming Zhang
- Department of Anatomy, University of Otago, Dunedin, New Zealand
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Yamashita K, Sakai T, Takata Y, Hayashi F, Tezuka F, Morimoto M, Kinoshita Y, Nagamachi A, Chikawa T, Yonezu H, Higashino K, Sakamaki T, Sairyo K. Utility of STIR-MRI in Detecting the Pain Generator in Asymmetric Bilateral Pars Fracture: A Report of 5 Cases. Neurol Med Chir (Tokyo) 2018; 58:91-95. [PMID: 29276206 PMCID: PMC5830529 DOI: 10.2176/nmc.cr.2017-0123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Lumbar spondylolysis usually occurs as a stress fracture in the pars interarticularis of the vertebra. It is a prevalent sports-related disorder and a common cause of low back pain. We encountered five athletes (4 males, 1 female) with severe low back pain. Mean age was 14.5 years. All five patients were found to have bilateral pars fracture. In all cases, staging based on the findings from computed tomography scan of the right and left pars fracture was different. On short tau inversion recovery magnetic resonance imaging (STIR-MRI) of the comparatively newer more recently injured side, high signal intensity changes were obvious and dominant at the intra- and extraosseous area, which would indicate tissue edema and/or bleeding. Furthermore, the imaging findings corresponded to the side of the low back pain. In conclusion, STIR-MRI can effectively distinguish between painful pars fracture and painless pars fracture.
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Abstract
STUDY DESIGN Radiologic analysis using computed tomography. OBJECTIVES To analyze the degenerative changes of the facet joints in patients with spondylolysis in comparison with control subjects. SUMMARY OF BACKGROUND DATA Defects of the pars interarticularis are thought to result in a reduction of biomechanical stress on adjacent facet joints. Therefore, degenerative changes of the facet joints in patients with spondylolysis are expected to be less than those in patients without spondylolysis. METHODS Abdominal and pelvic multidetector computed tomography scans of 2000 subjects, performed for conditions unrelated to low back pain, were reviewed. A total of 107 patients (37 women and 70 men) with L5 spondylolysis were identified [spondylolysis (+) group]. Sex-matched and age-matched controls without spondylolysis were chosen randomly [spondylolysis (-) group]. Subjects in the spondylolysis group were subdivided into either bilateral spondylolysis or unilateral spondylolysis groups for comparison with the control group. Four radiologic findings (narrowing, sclerosis, osteophyte, and bone cyst) indicative of degenerative change of the facet joints adjacent to the L5 pars defects were evaluated and the degree of degenerative change was graded by summing the number of degenerative changes (score range, 0-4). The χ test and Mann-Whitney U test were used for statistical analysis. RESULTS Significantly more degenerative changes in both L4/L5 and L5/S facet joints were found in the spondylolysis (+) group than in the spondylolysis (-) group (χ test, P <0.05). Degenerative changes of the facet joints at both L4/L5 and L5/S were more severe in the bilateral spondylolysis (+) group than in the spondylolysis (-) group. Degenerative changes of the facet joints at both L4/L5 and L5/S were more severe in the unilateral spondylolysis (+) group than in the spondylolysis (-) group. CONCLUSIONS Degenerative changes of the facet joints in patients with lumbar spondylolysis were more severe than those without spondylolysis.
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Yokoyama K, Yamashita K, Morimoto M, Tezuka F, Hayashi F, Takata Y, Sakai T, Higashino K, Chikawa T, Yonezu H, Nagamachi A, Sairyo K. Accurate diagnosis of chronic low back pain in a high-level college athlete: a case report. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 64:313-316. [DOI: 10.2152/jmi.64.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kenji Yokoyama
- Department of Orthopedics, Tokushima University Hospital
| | | | | | | | - Fumio Hayashi
- Department of Orthopedics, Tokushima University Hospital
| | | | | | | | | | - Hiroshi Yonezu
- Department of Orthopedics, Tokushima University Hospital
| | | | - Koichi Sairyo
- Department of Orthopedics, Tokushima University Hospital
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Compression Myelopathy due to Proliferative Changes around C2 Pars Defects without Instability. Asian Spine J 2016; 10:565-9. [PMID: 27340539 PMCID: PMC4917778 DOI: 10.4184/asj.2016.10.3.565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 12/02/2022] Open
Abstract
We report a case with compression myelopathy due to proliferative changes around the C2 pars defects without instability. A 69-year-old man presented with progressive clumsy hands and spastic gait. Plain radiographs showed bilateral spondylolysis (pars defects) at C2 and fusion between C2 and C3 spinous processes. Dynamic views revealed mobility through the pars defects, but there was no apparent instability. Computed tomography showed proliferative changes at the pars defects, which protruded into spinal canal. On magnetic resonance imaging, the spinal cord was compressed and intramedullary high signal change was found. A diagnosis of compression myelopathy due to proliferative changes around the C2 pars defects was made. We performed posterior decompression. Postoperatively, symptoms have been alleviated and images revealed sufficient decompression and no apparent instability. In patients with the cervical spondylolysis, myelopathy caused by instability or slippage have been periodically reported. The present case involving C2 spondylolysis is extremely rare.
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Sairyo K, Nagamachi A. State-of-the-art management of low back pain in athletes: Instructional lecture. J Orthop Sci 2016; 21:263-72. [PMID: 26850924 DOI: 10.1016/j.jos.2015.12.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/02/2015] [Accepted: 12/14/2015] [Indexed: 11/16/2022]
Abstract
In this paper, we describe "state of the art" on the diagnosis and treatment for low back pain in athletes. Lumbar motion that induces specific pain would be a clue to the exact diagnosis. In the flexion pain group, lumbar herniated nucleus pulposus is the most common disorder. Discogenic pain and type 1 Modic endplate inflammation may also cause flexion pain; however, the diagnosis is sometimes difficult. In children and adolescents, apophyseal ring fracture is prevalent. In the extension pain group, lumbar spondylolysis is very common, especially in pediatric athletes. In adults, facet pain due to overloading would be the pathology, while low back pain with trunk rotation is not common. However, throwing athletes, such as pitchers and hammer throwers, may experience this kind of pain; facet arthritis contralateral to the throwing arm would be the origin of the pain. Low back pain on lumbar lateral bending is rare, but we experienced some cases in golfers in whom type 1 Modic change at the lateral corner was the source of pain. In this article, we explained strategies for state-of-the-art diagnosis and minimally invasive treatment.
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Affiliation(s)
- Koichi Sairyo
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Akihiro Nagamachi
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
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Tenosynovial Giant Cell Tumor, Diffuse Type/Pigmented Villonodular Synovitis in a Pars Defect: A Case Report. Spine (Phila Pa 1976) 2015; 40:E735-9. [PMID: 26067150 DOI: 10.1097/brs.0000000000000923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a rare case of tenosynovial giant cell tumor, diffuse type/pigmented villonodular synovitis (PVNS) in a pars defect in a patient with lumbar spondylolysis. SUMMARY OF BACKGROUND DATE PVNS rarely occurred in lumbar spine, and no studies in the English literature have reported PVNS in a pars defect in lumbar spondylolysis. METHODS The patient was a 14-year-old female presented with a 5-month history of low back pain. Plain radiography showed spondylolysis at L5 and computed tomography revealed a 1 × 2-cm slightly eroding tumorous mass at the left L5 pars. On magnetic resonance imaging, the mass showed intermediate intensity and gadolinium enhancement on T1-weighted images (WI) and high intensity on T2-WI and T2 STAR-WI. After undergoing computed tomography-guided needle biopsy, a pathological diagnosis of PVNS was made and total gross resection was performed. RESULTS The gross appearance and the postoperative pathological diagnosis were consistent with PVNS. The postoperative clinical course was uneventful and postoperative computed tomography and magnetic resonance imaging revealed no residual lesion. CONCLUSION This is the first report of PVNS occurring in spondylolysis. LEVEL OF EVIDENCE N/A.
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Nishimura Y, Natsume A, Ginsberg HJ. Spinal dural arteriovenous fistula associated with L-4 isthmic spondylolisthesis. J Neurosurg Spine 2014; 20:670-4. [DOI: 10.3171/2014.3.spine13492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe a case of a 79-year-old man with a lumbar spinal dural arteriovenous fistula (DAVF) and isthmic spondylolisthesis at the same level. The patient's thoracic spine MRI study demonstrated swelling and increased T2 signal in the spinal cord and regional dilated perimedullary vessels. Lumbar spine MRI showed L-4 isthmic spondylolisthesis with severe bilateral L4–5 foraminal stenoses. Spinal angiography revealed a fistulous connection at the left L-4 nerve root sleeve between perimedullary veins and a dural branch of the L-4 radicular artery. Based on previous reports about secondary spinal DAVFs, the abnormal vascular communication likely developed secondary to the microtrauma and inflammation on the left L-4 nerve root sleeve, which was attributable to the isthmic spondylolisthesis. The authors performed disconnection of the arteriovenous shunt as well as an L4–5 decompression and posterior instrumented fusion with pedicle screws. The patient's postoperative course was uneventful, and he improved neurologically. It is important to bear in mind that a spinal DAVF may develop as a consequence of any sort of trauma or inflammation involving nerve roots. One should consider the concomitant treatment of both the spinal DAVF and the underlying pathology that may have given rise to the spinal DAVF.
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Affiliation(s)
- Yusuke Nishimura
- 1Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada; and
- 2Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | - Atsushi Natsume
- 2Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | - Howard J. Ginsberg
- 1Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada; and
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Lumbar spondylolysis in juveniles from the same family: a report of three cases and a review of the literature. Case Rep Orthop 2013; 2013:272514. [PMID: 24191211 PMCID: PMC3803119 DOI: 10.1155/2013/272514] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/02/2013] [Indexed: 11/21/2022] Open
Abstract
Spondylolysis is reported as a stress fracture of the pars interarticularis with a strong hereditary basis. Three cases of lumbar spondylolysis in juveniles from the same family are reported, and the genetics of the condition are reviewed. The first boy, a 13-year-old soccer player, was diagnosed with terminal stage L5 bilateral spondylolysis with grade 1 slippage. The second boy, a 10-year-old baseball player, had terminal stage right side unilateral spondylolysis. The third boy, also a 10-year-old baseball player, was diagnosed with early stage bilateral L5 spondylolysis. The second and third boys are identical twins, and all three cases exhibited concomitant spina bifida occulta. Lumbar spondylolysis has a strong hereditary basis and is reported to be an autosomal dominant condition.
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Multilevel direct repair surgery for three-level lumbar spondylolysis. Case Rep Orthop 2013; 2013:472968. [PMID: 23607020 PMCID: PMC3625543 DOI: 10.1155/2013/472968] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 03/07/2013] [Indexed: 01/30/2023] Open
Abstract
A 45-year-old man presented to our clinic requesting evaluation for surgical treatment of chronic low back pain of more than 20 years duration. He was diagnosed with 3-level lumbar spondylolysis at L3-5. Direct repair using the pedicle screw and hook-rod system was conducted for all three levels. After the surgery, his low back pain completely disappeared. Six months later, he felt discomfort and heard a metallic sound as he twisted his trunk. Computed tomography and radiography indicated that the hook head for L3 and the screw head for L4 were interfering with each other, causing the sound. We confirmed bony union at L3 and removed the L3 system. Surgeons should be aware of such complications if direct repair using a pedicle screw and hook-rod system is conducted for multilevel spondylolysis.
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Miyagi R, Sairyo K, Sakai T, Dezawa A. A remarkable case of hypertrophic pseudoarthrosis of the pars interarticularis in a young American football professional player. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 22 Suppl 1:1-3. [PMID: 26662738 DOI: 10.1007/s00590-011-0868-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 08/26/2011] [Indexed: 11/29/2022]
Abstract
Lumbar spondylolysis is a defect of the pars interarticularis regarded as a stress fracture. The bone stump around the pars defect usually appears atrophic and is fibrously united or filled with fibro cartilaginous mass, similar to long bone pseudoarthrosis. Lumbar spondylolysis sometimes causes bone growth resembling that of an osteophyte in osteoarthritis, and in elderly patients, the ragged edges result in radiculopathy around the defect. However, lumbar spondylolysis is rarely reported to cause hypertrophic changes resulting in spinal canal stenosis in young patients. In this report, we present an unprecedented radiological finding of distinctive hypertrophic change around the pars defect, which occurred in a young professional football player.
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Affiliation(s)
- Ryo Miyagi
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Koichi Sairyo
- Department of Orthopedic Surgery, School of Medicine, Teikyo University Mizonokuchi Hospital, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, 213-8507, Japan.
| | - Toshinori Sakai
- Department of Orthopaedic Surgery, University of California, Irvine, CA, USA
| | - Akira Dezawa
- Department of Orthopedic Surgery, School of Medicine, Teikyo University Mizonokuchi Hospital, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, 213-8507, Japan
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Sairyo K, Sakai T, Yasui N, Dezawa A. Conservative treatment for pediatric lumbar spondylolysis to achieve bone healing using a hard brace: what type and how long?: Clinical article. J Neurosurg Spine 2012; 16:610-4. [PMID: 22519929 DOI: 10.3171/2012.2.spine10914] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECT Various kinds of trunk braces have been used to achieve bone healing in cases of pediatric lumbar spondylolysis. However, the optimal brace for achieving bone healing is unclear. The purpose of the present study was to determine in what types of spondylolysis bone healing can be achieved and how long it takes. METHODS In this prospective study, 63 pars interarticularis defects (spondylolysis) among 37 patients who were younger than 18 years (mean 13.5 ± 2.7 years) were treated using a hard brace. The youngest patient was 8 years old. Based on the results of CT scanning, the lyses were classified into 3 categories: early, progressive, and terminal defects. Progressive defects were further divided into 2 types according to STIR MRI findings: those with high signal intensity at the adjacent pedicle and those with low signal intensity (that is, a normal appearance). A hard brace, such as a molded plastic thoracolumbosacral orthosis, was used to immobilize the trunk. Approximately every 3 months, CT scanning was performed to evaluate bone healing until approximately 6 months. RESULTS The union rates were 94%, 64%, 27%, and 0% for the early, progressive with high signal intensity, progressive with low signal intensity, and terminal defects, respectively. It was noted that no terminal defect was healed using conservative treatment. The mean time to healing among the defects that showed bone healing was 3.2, 5.4, and 5.7 months for the early, progressive with high signal intensity, and progressive with low signal intensity groups, respectively. CONCLUSIONS Patients with early-stage defects are the best candidates for conservative treatment with a hard brace because more than 90% of such cases can be healed in 3 months.
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Affiliation(s)
- Koichi Sairyo
- Department of Orthopaedic Surgery, School of Medicine, University of Teikyo, Mizonokuchi Hospital, Takatsu-ku, Kawasaki City, Kanagawa, Japan.
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