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Onoda Y, Kitagawa T. Effect of lumbar lordosis angle on the development of lumbar spondylolysis in adolescent baseball players: A cross-sectional study. J Orthop Sci 2024; 29:1183-1187. [PMID: 37891044 DOI: 10.1016/j.jos.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Lumbar spondylolysis (LS) is a lumbar vertebral arch stress fracture that often occurs in adolescent athletes, especially baseball players. An increase in lumbar lordosis angle (LLA) increases the compressive stress on the vertebral arch, influencing the development of LS. However, the effect of LLA on LS development in adolescent baseball players is unknown. Therefore, it is necessary to elucidate the risk factors that influence the development of LS. This cross-sectional study aimed investigate the effect of LLA on LS development in adolescent baseball players. METHODS Patients were male baseball players aged 11-18 years who visited an orthopedic clinic with a chief complaint of lumbar pain and underwent a magnetic resonance imaging (MRI) examination between January 1, 2018, and October 31, 2021. LLA was defined as the angle formed by the line parallel to the superior endplate of the L1 and S1. A person other than the data analyst measured LLA three times from the MRI, and the average value was used for data analysis. Logistic regression analysis was performed, with the presence or absence of LS as the objective variable and LLA, age, and previous pitching experience as explanatory variables. RESULTS Of the 112 subjects included, 79 were in the LS group and 33 in the non-LS group. The LLA was 45.42 ± 8.19° in the LS group and 36.68 ± 8.26° in the non-LS group, with significant differences between the groups. Logistic regression analysis showed that LLA significantly differed with an odds ratio of 1.140 (95% confidence interval: 1.070-1.21), even after adjusting for age and previous pitching experience. CONCLUSIONS LLA in adolescent baseball players was significantly greater in the LS group than in the non-LS group, which may influence the development of LS.
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Affiliation(s)
- Yuki Onoda
- Department of Rehabilitation, Hanamizuki Orthopedic Sports Clinic, 1-18-8 Kiyosu, Kiyosu, 452-0942, Japan.
| | - Takashi Kitagawa
- Department of Physical Therapy, School of Health Sciences, Shinshu University, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
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Hiranaka Y, Miyazaki S, Inoue S, Ryu M, Kuroshima K, Yurube T, Kakutani K, Tadokoro K. Clinical Features and Therapeutic Process of Sacral Fatigue Fractures in Adolescents. Am J Sports Med 2024; 52:2046-2054. [PMID: 38819096 DOI: 10.1177/03635465241251848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Sacral fatigue fractures are a rare injury but should be considered as a differential diagnosis for low back and buttock pain in young adults. Collective reports are limited, most of which have focused on long-distance runners. PURPOSE To investigate the characteristics of sacral fatigue fractures in adolescents. STUDY DESIGN Case series; Level of evidence, 4. METHODS We analyzed patient background characteristics, physical examination and imaging findings, and treatment courses of those diagnosed with sacral fatigue fractures using magnetic resonance imaging. RESULTS Among 34 patients with sacral fatigue fractures, 15 and 19 were male and female patients, respectively, with an age range of 11 to 19 years (mean age, 15.0 years). Almost all patients were athletes, and 29 patients performed their sport ≥5 times a week. Long-distance runners were the most commonly affected, comprising 7 patients, and participants in other common sports such as baseball (6 patients), basketball (4 patients), and soccer (3 patients) were also affected. Physical examination revealed tension sign (Lasègue test) on the affected side in 6 patients and tight hamstrings in 24 patients. Imaging findings included 18 patients with right-side involvement, 12 with left-side involvement, and 4 with involvement on both sides. In 11 patients, spina bifida occulta was observed at S1 and 8 patients had a history of lumbar spondylolysis with 4 patients having concurrent sacral fatigue fractures. Physical therapy was performed concurrently with the cessation of exercise, and return to exercise was permitted if the pain had been relieved after 1 month. All patients returned to sports at a median of 48 days (range, 20-226 days) after symptom onset. However, 2 patients experienced recurrence (1 patient on the ipsilateral side and 1 patient on the contralateral side). CONCLUSION Sacral stress fractures are not limited to long-distance runners in this population and can manifest as lower back pain or buttock pain in athletes participating in a variety of sports. Although the course of treatment was generally good, the possibility of recurrence must always be considered.
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Affiliation(s)
- Yoshiaki Hiranaka
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe City, Hyogo Prefecture, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shingo Miyazaki
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe City, Hyogo Prefecture, Japan
| | - Shinichi Inoue
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe City, Hyogo Prefecture, Japan
| | - Masao Ryu
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe City, Hyogo Prefecture, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kohei Kuroshima
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe City, Hyogo Prefecture, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | | | - Ko Tadokoro
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe City, Hyogo Prefecture, Japan
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Aoyagi M, Naito K, Morimoto K, Kobayashi A. Are trunk muscle sizes different between acute lumbar spondylolysis and nonspecific low back pain? J Bodyw Mov Ther 2024; 39:299-303. [PMID: 38876642 DOI: 10.1016/j.jbmt.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 01/03/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Morphological differences in the trunk muscles between adolescent athletes with lumbar spondylolysis (LS) and nonspecific low back pain (NSLBP) have not been fully elucidated. This study aimed to investigate the differences in physiological cross-sectional areas (CSA) of the trunk muscles between athletes with acute LS and those with acute NSLBP. METHODS Magnetic resonance images of 48 patients aged 13-14 years diagnosed with acute LS or NSLBP were retrospectively evaluated. The CSA of the paraspinal, psoas major, and rectus abdominis muscles at the L4-5 intervertebral disc level were measured. RESULTS CSA of the left and right paraspinal muscles in the acute LS group were significantly larger than those in the acute NSLBP group (left: mean difference, 276.0 mm2; 95% confidence interval [CI], 68.5-483.6 mm2; P = 0.01; right: mean difference, 228.8 mm2; 95% CI, 7.6-450.1 mm2; P = 0.04). The ratio between the left paraspinal muscles and left psoas major in the acute LS group was significantly larger than that in the acute NSLBP group (mean difference, 0.2; 95% CI, 0.0-0.4; P = 0.03). CONCLUSIONS Trunk muscle size may differ between adolescent athletes with acute LS and those with NSLBP. Future research involving healthy controls is required to better understand the morphological characteristics of these injuries.
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Affiliation(s)
- Masashi Aoyagi
- Juntendo Administration for Sports, Health and Medical Sciences, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Kei Naito
- Forest Orthopaedic Sports Clinic, 180-1 Furuichi-machi, Maebashi, Gunma, 371-0844, Japan
| | - Koji Morimoto
- Faculty of Rehabilitation, Department of Physical Therapy, Tokyo Professional University of Health Science, 2-22-10 Shiohama, Kotouku, Tokyo, 135-0043, Japan
| | - Atsushi Kobayashi
- Forest Orthopaedic Sports Clinic, 180-1 Furuichi-machi, Maebashi, Gunma, 371-0844, Japan
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Motomura Y, Tateuchi H, Ota M, Miyakoshi K, Asayama A, Nojiri S, Nakao S, Yagi M, Ichihashi N. Effects of abdominal hollowing and bracing on each intervertebral angle during quadruped upper and lower extremity lift: Three-dimensional motion analysis of the spine. J Biomech 2024; 170:112128. [PMID: 38797083 DOI: 10.1016/j.jbiomech.2024.112128] [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] [Received: 10/31/2023] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024]
Abstract
To investigate the effects of intentionally minimizing spinal motion and abdominal muscle contractions on intervertebral angles during quadruped upper and lower extremity lift (QULEL). Fifteen healthy men performed the QULEL under four conditions: without any special instructions (basic), with the intention to minimize spinal motion (intentional), with abdominal bracing (bracing), and with abdominal hollowing (hollowing). Each intervertebral angle was calculated from the local coordinate system using the marker data obtained from a motion capture system. Shear moduli, as indicators of the activities of the right transversus abdominis (TrA), internal and external oblique, and rectus abdominis muscles, were assessed using shear wave elastography during QULEL. One-way repeated-measures analysis of variance and multiple comparisons among conditions were used to compare each shear modulus of the abdominal muscle and the changes in thoracic kyphosis (Th1-12), lumbar lordosis (L1-5), and lumbar intervertebral angles from the quadruped position to QULEL. The significance level was set at P < 0.05. Changes in lumbar lordosis and L2/L3 and L3/L4 extension angles were significantly lower under hollowing than under other conditions (effect size ηG2: lumbar lordosis, 0.068; L2/L3, 0.072; L3/L4, 0.043). The change in the L1/L2 extension angle significantly decreased in bracing and hollowing compared with the basic (ηG2 = 0.070). Only the TrA shear modulus significantly increased in bracing and hollowing compared with the basic (ηG2 = 0.146). Abdominal hollowing during the QULEL increased TrA activity and suppressed lumbar extension, except at L4/L5, and may be more effective as a rehabilitation exercise for controlling spinal motion.
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Affiliation(s)
- Yoshiki Motomura
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan; Kobayashi Orthopaedic Clinic, Kyoto, Kyoto, Japan
| | - Hiroshige Tateuchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan.
| | - Megumi Ota
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan; Faculty of Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kosuke Miyakoshi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Akihiro Asayama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan; Department of Rehabilitation, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan
| | - Shusuke Nojiri
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan; Department of Rehabilitation, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Sayaka Nakao
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan; Faculty of Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
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Lima MVD, Caffaro MFS, Santili C, Watkins IV RG. Spondylolysis and Spondylolisthesis in Athletes. Rev Bras Ortop 2024; 59:e10-e16. [PMID: 38524709 PMCID: PMC10957283 DOI: 10.1055/s-0043-1777435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/29/2023] [Indexed: 03/26/2024] Open
Abstract
This article is an update on spondylolysis and spondylolisthesis in athletes, from diagnosis to treatment, based on our service experience and a literature review.
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Affiliation(s)
- Marcos Vaz de Lima
- Grupo de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Maria Fernanda Silber Caffaro
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Claudio Santili
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
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Narendran N, Nilssen PK, Walker CT, Skaggs DL. New technique and case report: Robot-assisted intralaminar screw fixation of spondylolysis in an adolescent. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100284. [PMID: 38025938 PMCID: PMC10654584 DOI: 10.1016/j.xnsj.2023.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 12/01/2023]
Abstract
Introduction Management of spondylolysis in adolescents is generally successful with conservative management. Uncommonly, surgical fixation is necessary for refractory cases. Direct repair with intralaminar screws is one commonly utilized technique. Recently, less invasive spinal procedures are becoming viable with the enabling of technologies, including robotics. Case description A 14-year-old baseball player and surfer presented with low back pain, diagnosed by MRI as bony edema and stress fractures of the posterior spinal elements. After 18 months, the pain was unresponsive to rest, physical therapy, and bracing. There was no radicular pain or neurologic symptoms. Computed tomography (CT) revealed bilateral, chronic nonhealing pars defects at L5. He underwent outpatient, robot-assisted percutaneous intralaminar fixation with hydroxyapatite-coated screws through a 2 cm skin incision. Outcome On postoperative day 1, the patient reported relief of his preoperative pain and he was ambulating without difficulty. At 2 weeks follow-up, the patient was completely pain free and surfing. At 2 months follow-up, low-dose CT demonstrated partial incorporation of the hydroxyapatite-coated screws, and the patient returned to sports. At 6 months follow-up, the patient had no pain and was swinging his baseball bat with full force. Low-dose CT revealed complete healing of the defects with full incorporation of the hydroxyapatite-coated screws. Conclusions A novel minimally invasive robotic percutaneous approach for direct spondylolysis repair using hydroxyapatite-coated screws is a potential surgical treatment option for non-healing pars defects in adolescent patients.
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Affiliation(s)
- Nakul Narendran
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
| | - Paal K. Nilssen
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
| | - Corey T. Walker
- Department of Neurosurgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
| | - David L. Skaggs
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
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Park S, Song Y, Oh S, Kim YU. Optimal cutoff point of vertebral body cross-sectional area as a morphological parameter for predicting lumbar spondylolysis. Medicine (Baltimore) 2023; 102:e35173. [PMID: 37713872 PMCID: PMC10508529 DOI: 10.1097/md.0000000000035173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
The relationship between vertebral body cross-sectional area (VBCSA) and spinal conditions associated with increased lumbar lordosis, such as lumbar spondylolysis (LSL), is not known. We investigated the morphological parameter, VBCSA, to predict LSL. The VBCSA on MRI has not been studied for its association with LSL. We hypothesized that VBCSA is an important morphological parameter for LSL prediction. We collected VBCSA data from 90 patients (43 males and 47 females) with LSL and 91 control subjects (44 males and 47 females) who underwent lumbar spine magnetic resonance imaging (LS-MRI). Axial T2-weighted LS-MRI images were obtained from all participants. Using our picture archiving and communications system, we analyzed the VBCSA at the level of the L5 vertebral body by utilizing MRI. The average VBCSA was 2263.51 ± 306.02 mm2 in the male control group and 1820.92 ± 224.89 mm2 in the male LSL group. LSL patients had significantly lower VBCSAs (P < .001) than did the male controls. The average VBCSA was 1985.21 ± 258.05 mm2 in the female control group and 1553.73 ± 250.02 mm2 in the female LSL group, and the LSL patients also had significantly lower VBCSAs (P < .001) than did the female controls. The optimal VBCSA cutoff value in the male group was 2014.69 mm2 with 76.7% sensitivity, 75.0% specificity, and an area under the receiver operating curve (AUC) of 0.89 (95% CI: 0.82-0.95). In the female group, the optimal cutoff score was 1814.11 mm2 with 76.6% sensitivity, 76.6% specificity, and an AUC of 0.88 (95% CI: 0.82-0.95). VBCSA is a sensitive objective morphological parameter for assessing LSL, and a lower VBCSA is associated with a higher possibility of LSL. We believe that these results will be useful in diagnostic radiology for evaluating patients with LSL.
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Affiliation(s)
- SoYoon Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Yumin Song
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Seonmin Oh
- Catholic Kwandong University of Korea College of Medicine, Gangneung, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
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Ross R, Han J, Slover J. Chronic Lower Back Pain in Weight Lifters: Epidemiology, Evaluation, and Management. JBJS Rev 2023; 11:01874474-202306000-00011. [PMID: 37315158 DOI: 10.2106/jbjs.rvw.22.00228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
» Chronic lower back pain (LBP) is common in both nonathletes and weight lifters, but the diagnosis and treatment should be approached differently in these 2 populations based on the unique movement patterns causing the pain.» Injury rates of weight lifters are far less than those of contact sports, ranging from 1.0 to 4.4 injuries per 1,000 workout hours. However, the lower back was consistently one of the top 2 injury sites for weight lifters, accounting for anywhere from 23% to 59% of all injuries. LBP was most often associated with the squat or deadlift.» Guidelines for evaluating general LBP are applicable to weight lifters, including a thorough history and physical examination. However, the differential diagnosis will change based on the patient's lifting history. Of the many etiologies of back pain, weight lifters are most likely to be diagnosed with muscle strain or ligamentous sprain, degenerative disk disease, disk herniation, spondylolysis, spondylolisthesis, or lumbar facet syndrome.» Traditional recommended therapies include nonsteroidal anti-inflammatory drugs, physical therapy, and activity modification, which are often insufficient to resolve pain and prevent injury recurrence. Because most athletes will want to continue to lift weights, lifting-specific behavior modifications focused on improved technique and correcting mobility and muscular imbalances are important aspects of management in this patient population.
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Affiliation(s)
- Ruby Ross
- NYU Grossman School of Medicine, New York, New York
| | - Julie Han
- NYU Grossman School of Medicine, New York, New York
| | - James Slover
- NYU Grossman School of Medicine, New York, New York
- Lenox Hill Hospital, New York, New York
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Hamada Y, Okubo Y, Hattori H, Nazuka T, Kikuchi Y, Akasaka K. Relationship between Isokinetic Trunk Muscle Strength and Return to Sports Competition after Conservative Therapy in Fresh Cases of Lumbar Spondylolysis: A Retrospective Observational Study. Healthcare (Basel) 2023; 11:healthcare11040625. [PMID: 36833159 PMCID: PMC9957178 DOI: 10.3390/healthcare11040625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/11/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
This study aimed to clarify the relationship between isokinetic trunk muscle strength and return to sporting activities in fresh cases of lumbar spondylolysis treated with conservative therapy. Patients included a total of ten men (age: 13.5 ± 1.7) who were instructed by their attending physicians to stop exercising and who met the eligibility criteria. Isokinetic trunk muscle strength was measured immediately after exercising for the first time (First) and one month (1M). Flexion and extension and maximum torque/body weight ratio were significantly lower First compared to 1M at all angular velocities (p < 0.05). Maximum torque generation time was significantly lower for First at 120°/s and 180°/s than at 1M (p < 0.05). Correlations with the number of days to return to sports competition were detected at 60°/s for maximum torque generation time (p < 0.05, r = 0.65). Following conservative treatment for lumbar spondylolysis, it was considered necessary to focus on trunk flexion and extension muscle strength and contraction speed of trunk flexors at the beginning of the exercise period. It was suggested that trunk extension muscle strength in the extension range might be one of the critical factors for returning to sports.
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Affiliation(s)
- Yuji Hamada
- Graduate School of Medicine, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
- Department of Rehabilitation, Kawagoe Clinic, Saitama Medical University, 7-21 Wakitahontyo, Moroyama 350-0495, Japan
| | - Yu Okubo
- Graduate School of Medicine, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
- School of Physical Therapy, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
| | - Hiroshi Hattori
- Graduate School of Medicine, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
- School of Physical Therapy, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
| | - Takeshi Nazuka
- Department of Rehabilitation, Kawagoe Clinic, Saitama Medical University, 7-21 Wakitahontyo, Moroyama 350-0495, Japan
| | - Yuto Kikuchi
- Graduate School of Medicine, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
- Department of Rehabilitation, Kawagoe Clinic, Saitama Medical University, 7-21 Wakitahontyo, Moroyama 350-0495, Japan
| | - Kiyokazu Akasaka
- Graduate School of Medicine, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
- School of Physical Therapy, Saitama Medical University, 981 Kawakado, Moroyama 350-0495, Japan
- Correspondence: ; Tel.: +81-49-295-1001
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Espí-López GV, Ruescas-Nicolau MA, Castellet-García M, Suso-Martí L, Cuenca-Martínez F, Marques-Sule E. Effectiveness of Foam Rolling vs. Manual Therapy in Postexercise Recovery Interventions for Athletes: A Randomized Controlled Trial. J Strength Cond Res 2022; 37:e361-e368. [DOI: 10.1519/jsc.0000000000004383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Aoyagi M, Naito K, Sato Y, Kobayashi A, Sakamoto M, Tumilty S. Developing clinical algorithm for identifying acute lumbar spondylolysis in elementary school children - Classification and regression tree analysis. J Man Manip Ther 2022; 30:342-349. [PMID: 35343399 PMCID: PMC9621212 DOI: 10.1080/10669817.2022.2056310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To develop a clinical algorithm for classifying acute lumbar spondylolysis from nonspecific low back pain in elementary school-aged patients using the classification and regression tree analysis. METHODS Medical records of 73 school-aged patients diagnosed with acute lumbar spondylolysis or nonspecific low back pain were retrospectively reviewed. Fifty-eight patients were examined for establishing an algorithm and 15 were employed for testing its performance. The following data were retrieved: age, gender, school grades, days after symptom onset, history of low back pain, days of past low back pain, height, weight, body mass index, passive straight leg raise test results, hours per week spent on sports activities, existence of spina bifida, lumbar lordosis angle, and lumbosacral joint angle. Classification and regression tree analyses were performed 150 times using the bootstrap and aggregating method. Then, the results were integrated by majority vote, establishing an algorithm. RESULTS Lumbar lordosis angle, days after symptom onset, body mass index, and lumbosacral joint angle were the predictors for classifying those injuries. CONCLUSION The algorithm can be used to identify elementary school-aged children with low back pain requiring advanced imaging investigation, although a future study with a larger sample population is necessary for validating the algorithm.
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Affiliation(s)
- Masashi Aoyagi
- Forest Orthopaedic Sports Clinic, Maebashi, Japan,Graduate School of Health Sciences, Gunma University, Maebashi, Japan,CONTACT Masashi Aoyagi Forest Orthopaedic Sports Clinic, 180-1 Furuichi-machi, Maebashi, Gunma371-0844, Japan
| | - Kei Naito
- Forest Orthopaedic Sports Clinic, Maebashi, Japan
| | - Yuichi Sato
- Forest Orthopaedic Sports Clinic, Maebashi, Japan
| | | | - Masaaki Sakamoto
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Steve Tumilty
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Lawrance SE, Boss E, Jacobs M, Day C. Current Clinical Concepts: Management of Common Lumbar Spine Posterior Column Disorders in Young, Active Individuals. J Athl Train 2022; 57:1021-1029. [PMID: 35788849 PMCID: PMC9875703 DOI: 10.4085/1062-6050-0161.21] [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: 01/28/2023]
Abstract
Although posterior column disorders, such as spondylolysis and spondylolisthesis, are not commonly encountered in the general population, athletic trainers frequently see these conditions in athletic and active individuals due to the repetitive spinal extension and rotational loads placed on the pars interarticularis while participating in sport. Athletic trainers can successfully evaluate patients with posterior column disorders by performing a complete and comprehensive clinical examination to identify the location of pain, test spinal stability, and recognize compensatory movement patterns. Conservative management typically leads to a successful outcome in this population, with rest, bracing, and the use of therapeutic exercise having the best supporting evidence. In this Current Clinical Concepts review, we outlined the etiology and risk factors frequently associated with disorders of the posterior column. Additionally, we synthesized the literature for common evaluation techniques and interventions associated with the posterior column and provided a proposed rehabilitation progression to use in a younger, athletic population.
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Affiliation(s)
- Scott E. Lawrance
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Emily Boss
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Meghan Jacobs
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Carly Day
- Department of Intercollegiate Athletics, Purdue University, West Lafayette, IN
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Vij N, Naron I, Tolson H, Rezayev A, Kaye AD, Viswanath O, Urits I. Back pain in adolescent athletes: a narrative review. Orthop Rev (Pavia) 2022; 14:37097. [PMID: 35936806 PMCID: PMC9353696 DOI: 10.52965/001c.37097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/25/2022] [Indexed: 04/28/2024] Open
Abstract
Background Back pain in young athletes is common. Adolescents are at an increased risk for back pain related to several factors including rapid growth. Traditionally, the conversation around back pain in the adolescent age group has been centered around diagnosis and treatment; however, there are emerging studies regarding prevention. Objective The purpose of the present investigation is to summarize sport-specific risk factors, to describe the growing emphasis on prevention/screening, and report results on minimally invasive and surgical options. Methods The literature search was performed in Mendeley. Search fields were varied until redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. The full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by at least 3 authors until an agreement was reached. Results Adolescent athletes have a higher risk of developing spondylolysis and spondylolisthesis than their non-athletic counterparts. Participation in athletic activity alone, increased body mass index, varsity status, and nationally/internationally competitive status are identified are demographic risk factors. Weightlifters, gymnasts, football players, and combat athletes may be at higher risks. Increased lumbar lordosis, abdominal muscle weakness, hip flexor tightness, hamstring tightness, thoracolumbar fascia tightness, femoral anteversion, genu recurvatum, and thoracic kyphosis also predispose. Recent cadaveric and kinematic studies have furthered our understanding of pathoanatomic. There is some evidence to suggest that isokinetic testing and electromyographic data may be able to identify at-risk individuals. Perturbation-based exercise interventions can reduce the incidence of adolescent athletic back pain. There is a large body of evidence to support the efficacy of physical therapy. There is some data to support minimally invasive treatments including external bone growth simulators, steroid injections, and chemonucleolysis for specific pathologies. Endoscopic surgery results for a limited subset of patients with certain disease processes are good. Conclusions Back pain in adolescent athletes is common and may not lead to appropriate alterations in athletes' level of participation. Athletes with a higher body mass index should be counseled regarding the benefits of losing weight. Isokinetic testing and electromyographic data have the potential as diagnostic and screening tools. Strength deficits and postural control could be used to identify patients requiring early intervention and thus reduce the incidence. External bone growth simulators, steroid injections, and chemonucleolysis could potentially become conservative options in the future. When surgery is indicated, the endoscopic intervention has the potential to decrease operative time, decrease cost, and promote healing.
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Affiliation(s)
- Neeraj Vij
- University of Arizona College of Medicine - Phoenix
| | - Ian Naron
- Louisiana State University Health Shreveport School of Medicine
| | | | - Arthur Rezayev
- Louisiana State University Health Shreveport School of Medicine
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport
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Cejudo A, Centenera-Centenera JM, Santonja-Medina F. The Potential Role of Hamstring Extensibility on Sagittal Pelvic Tilt, Sagittal Spinal Curves and Recurrent Low Back Pain in Team Sports Players: A Gender Perspective Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168654. [PMID: 34444402 PMCID: PMC8393976 DOI: 10.3390/ijerph18168654] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 12/05/2022]
Abstract
It is assumed that mechanical restriction of hamstring tightness disrupts sagittal spine–pelvis–leg alignment and alters the lumbar–pelvic rhythm predisposing to low back pain (LBP) in athletes; however, this association is not clear. A prospective cross-sectional cohort study was conducted to determine the influence of hamstring extensibility (HE) on sagittal pelvic tilt, sagittal spinal curves, and LBP in 94 soccer and basketball players (61 man and 33 woman) with (n = 36) and without recurrent LBP (n = 58). Descriptive analysis displayed significant gender differences for HE, sagittal pelvic tilt, and lumbar curve. Differences were found between the low-HE and high-HE groups in lumbosacral angle in for the maximum trunk forward flexion (LH-MTFP). Low-HE was associated with LH-MTFP, lumbar curve and LBP in male players (p ≤ 0.023). In female players, LH-MTFP and lumbar curve were associated with low-HE (p ≤ 0.020). Low-HE predicted LH-MTFP (p = 0.000; OR = 65.6950) and LBP (p = 0.028; OR = 13.915) in male players. The decision tree analysis showed that 50.8% of the players were classified with restricted LH-MTFP, 77.4% with low-HE among male players. The 100% of male players with recurrent LBP had low-HE. The 65% of female players with low-HE had restricted LH-MTFP. Measurement of HE, lumbar curve, and LH-MTFP are important in making training decisions for to reduce the incidence of recurrent LBP in soccer and basketball players.
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Affiliation(s)
- Antonio Cejudo
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30100 Murcia, Spain
- Correspondence: (A.C.); (J.M.C.-C.); Tel.: +34-868-888-430 (A.C.); +34-972-204-350 (J.M.C.-C.)
| | - Josep María Centenera-Centenera
- Department of Surgery, Traumatology and Orthopedics, Bofill Clinic, 17002 Gerona, Spain
- Correspondence: (A.C.); (J.M.C.-C.); Tel.: +34-868-888-430 (A.C.); +34-972-204-350 (J.M.C.-C.)
| | - Fernando Santonja-Medina
- Department of Surgery, Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30100 Murcia, Spain;
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15
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Cejudo A, Centenera-Centenera JM, Santonja-Medina F. Sagittal Integral Morphotype of Competitive Amateur Athletes and Its Potential Relation with Recurrent Low Back Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168262. [PMID: 34444009 PMCID: PMC8392335 DOI: 10.3390/ijerph18168262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022]
Abstract
Athletes have higher thoracic and lumbar curvature in standing than the reference values of the non-athletic population. The sagittal integral morphotype method (SIM) assessment has not previously been applied to competitive amateur athletes (CAA). The propose of the present study was to determine the SIM of CAA treated at a sports-medicine center and to identify spinal misalignments associated with recurrent low back pain (LBP). An observational analysis was developed to describe the SIM in 94 CAA. The thoracic and lumbar curvatures of the CAA were measured in standing, sitting, and trunk forward flexion. Association analysis (Pearson’s chi-square and Cramér’s V tests) was then performed to identify the SIM misalignments associated with LBP. Effect size was analyzed based on Hedges’ g. The most common thoracic SIMs in CAA were total hyperkyphosis (male = 59.02%; female = 42.42%) and static hyperkyphosis (male = 11.48%; female = 6.06%). Hyperlordotic attitude (female = 30.30%; male = 4.92%), static-functional hyperkyphosis (male = 16.39%; female = 3.03%), and structured hyperlordosis (female = 21.21%; male = 1.64%) were the most common lumbar SIMs. Hyperlordotic attitude, static functional lumbar hyperkyphosis, and structured hyperlordosis were associated with LBP in male and female athletes.
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Affiliation(s)
- Antonio Cejudo
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30100 Murcia, Spain
- Correspondence: (A.C.); (J.M.C.-C.); Tel.: +34-868-88-84-30 (A.C.); +34-972-20-43-50 (J.M.C.-C.)
| | - Josep María Centenera-Centenera
- Department of Surgery, Traumatology and Orthopedics, Bofill Clinic, ProActive Health, 17002 Gerona, Spain
- Correspondence: (A.C.); (J.M.C.-C.); Tel.: +34-868-88-84-30 (A.C.); +34-972-20-43-50 (J.M.C.-C.)
| | - Fernando Santonja-Medina
- Department of Surgery, Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, 30100 Murcia, Spain;
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Aoyagi M, Naito K, Sato Y, Kobayashi A, Sakamoto M, Tumilty S. Identifying Acute Lumbar Spondylolysis in Young Athletes with Low Back Pain: Retrospective Classification and Regression Tree Analysis. Spine (Phila Pa 1976) 2021; 46:1026-1032. [PMID: 33395023 DOI: 10.1097/brs.0000000000003922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case-control study. OBJECTIVE The aim of this study was to establish an algorithm to distinguish acute lumbar spondylolysis (LS) from nonspecific low back pain (NSLBP) among patients in junior high school by classification and regression tree (CART) analysis. SUMMARY OF BACKGROUND DATA Rapid identification of acute LS is important because delayed diagnosis may result in pseudarthrosis in the pars interarticularis. To diagnose acute LS, magnetic resonance imaging (MRI) or computed tomography is necessary. However, not all adolescent patients with low back pain (LBP) can access these technologies. Therefore, a clinical algorithm that can detect acute LS is needed. METHODS The medical records of 223 junior high school-aged patients with diagnosed acute NSLBP or LS verified by MRI were reviewed. A total of 200 patients were examined for establishing the algorithm and 23 were employed for testing the performance of the algorithm. CART analysis was applied to establish the algorithm using the following data; age, sex, school grades, days after symptom onset, history of LBP, days of past LBP, height, passive straight leg raising test results, hours per week spent in sports activities, existence of spina bifida, lumbar lordosis angle, and lumbosacral joint angle. Sensitivity and specificity of the algorithm and the area under the ROC curve were calculated to assess algorithm performance. RESULTS The algorithm revealed that sex, days after symptom onset, days of past LBP, hours per week spent in sports activities, and existence of spina bifida were key predictors for identifying acute LS versus NSLBP. Algorithm sensitivity was 0.64, specificity was 0.92, and the area under the ROC curve was 0.79. CONCLUSION The algorithm can be used in clinical practice to distinguish acute LS from NSLBP in junior high school athletes, although referral to MRI may be necessary for definitive diagnosis considering the algorithm's sensitivity.Level of Evidence: 4.
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Affiliation(s)
- Masashi Aoyagi
- Forest Orthopaedic Sports Clinic, Gunma, Japan
- Graduate School of Health Sciences, Gunma University, Gunma, Japan
| | - Kei Naito
- Forest Orthopaedic Sports Clinic, Gunma, Japan
| | - Yuichi Sato
- Forest Orthopaedic Sports Clinic, Gunma, Japan
| | | | - Masaaki Sakamoto
- Graduate School of Health Sciences, Gunma University, Gunma, Japan
| | - Steve Tumilty
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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17
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Increased sagittal diameter of the vertebral arch aids in diagnosis of lumbar spondylolysis. Skeletal Radiol 2021; 50:1125-1130. [PMID: 33112978 PMCID: PMC8035112 DOI: 10.1007/s00256-020-03658-8] [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: 08/26/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify a diagnostic indicator of lumbar spondylolysis visible in plain X-ray films. METHODS One hundred and seventy-two patients with low back pain who received X-ray and computerized tomography (CT) examinations were identified and studied. They were divided into three groups: the spondylosis without spondylolisthesis (SWS) group, comprising 67 patients with bilateral pars interarticularis defects at L5 and without spondylolisthesis, the isthmic spondylolisthesis (IS) group, comprising 74 patients with L5/S1 spondylolisthesis and bilateral L5 pars interarticularis defects, and the control group, comprising 31 patients with low back pain but without spondylolysis. The sagittal diameters of the vertebral arch (SDVAs) of L4 and L5 were measured in lateral X-ray image, and the differences in SDVA between L4 and L5 (DSL4-5) in each case were calculated and analyzed. RESULTS There were no significant differences in demographic characteristics among the three groups. In the SWS and IS groups, the SDVA of L5 was significantly longer than the SDVA of L4 (p < 0.001), whereas no significant difference found in the control group (p > 0.05). DSL4-5, in which the SDVA of L4 was subtracted from the SDVA of L5, significantly differed among the three groups (p < 0.001), and the normal threshold was provisionally determined to be 1.55 mm. CONCLUSIONS In bilateral L5 spondylolysis, the SDVA of L5 is wider than the SDVA of L4, and this difference is greater in isthmic spondylolisthesis. This sign in lateral X-rays may provide a simple and convenient aid for the diagnosis of spondylolysis.
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18
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CONSIDERATION OF SPORT DEMANDS FOR AN 18-YEAR-OLD LACROSSE PLAYER WITH RECALCITRANT SYMPTOMATIC SPONDYLOLYSIS: A CASE REPORT. Int J Sports Phys Ther 2020; 15:1196-1210. [PMID: 33344035 DOI: 10.26603/ijspt20201196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Spondylolysis is an anatomical defect or fracture of the pars interarticularis and encompasses almost half of all cases of low back pain in adolescent athletes. Most athletes return to sport with conservative treatment, but it is possible that consideration of sport demands may further improve rate of successful return. When surgery is performed, complication rate is high, so all conservative measures should be explored before considering surgical intervention. The purpose of this case report is to present a program where demands of sport were considered and allowed successful return to sport for a subject with recalcitrant symptomatic spondylolysis that had failed to respond to prior treatment. Case Description An 18-year-old lacrosse player with a history of recalcitrant symptomatic spondylolysis that failed three courses of conservative treatment and had been unsuccessful in returning to sport. A multi-phase program with a focus on multi-planar and full kinetic chain activities that addressed the nature of the sport demands is described, along with improvements in pain level, strength, range of motion, and subjective outcome scores. Outcomes The subject was able to successfully return to sport after 10 weeks of physical therapy and complete the remaining few months of his lacrosse season without reinjury. Range of motion and strength testing was markedly improved upon discharge. The subject's Modified Oswestry Disability Index improved from 16% to 0% and his pain level did not rise above 2/10 with any sport activity upon return. Discussion/Conclusions Although return to sport rates following spondylolysis in young athletes is high, this case report demonstrates that a consideration of sport demands may increase return to sport rates in athletes that do not respond to standard care and prevent surgical intervention. Level of Evidence Level 4, single case report.
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19
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Ruff AN, Cornelson SM, Wells CB, Kettner NW. Neural Arch Bone Marrow Edema and Spondylolysis in Adolescent Cheerleaders: A Case Series. J Chiropr Med 2020; 18:335-342. [PMID: 32952480 DOI: 10.1016/j.jcm.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/03/2019] [Accepted: 02/17/2019] [Indexed: 10/23/2022] Open
Abstract
Objective Spondylolysis is 1 of the most common sources of low back pain in children and adolescents; however, there is still a great deal of confusion in regard to etiology, clinical presentation, and diagnostic imaging findings. It is imperative for clinicians to recognize that persistent low back pain is strongly indicative of spondylolysis, especially in high-performance athletes. This case series demonstrates a comprehensive diagnostic spectrum of spondylolysis and its treatment in 2 competitive adolescent cheerleaders. Clinical Features In case 1, a 12-year-old female competitive cheerleader presented with a gradual onset of subacute low back pain. Comprehensive clinical examination indicated imaging studies that identified bilateral L5 grade 1 stress reaction, consisting of neural arch bone marrow edema (BME). Treatment included spinal adjustments, rehabilitation, and myofascial therapy. In case 2, 15-year-old female competitive cheerleader presented with insidious chronic low back pain that was provocative with extension. Magnetic resonance imaging revealed a left L5 grade 1 pars interarticularis stress reaction. Computed tomography demonstrated right L5 pars grade 3 and left L5 healing spondylolysis. Treatment included spinal adjustments and rehabilitation exercises. She was also seen by a physical therapist who prescribed a lumbar spine flexion brace. Intervention and Outcome Diagnosis of BME and spondylolysis led to temporary cessation of cheerleading activities in cases 1 and 2. The individual in case 1 self-discharged with a list of rehabilitation exercises and was lost to follow-up. The individual in case 2 was able to return to sport pain free approximately 5 weeks after seeking treatment. Conclusion Spondylolysis is common in adolescent athletes, and the presence of BME precedes spondylolysis. Primary spine providers could consider this diagnosis in any adolescent, especially an athlete, who has persistent low back pain. Timely diagnosis will optimize treatment outcomes.
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Affiliation(s)
- Ashley N Ruff
- Radiology Department, Logan University, Chesterfield, Missouri
| | | | - Courtney B Wells
- Human Performance Center, Logan University, Chesterfield, Missouri
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20
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Abstract
BACKGROUND The lumbar spine forms the lowermost part of the mobile spinal column. Due to anatomical properties, the lumbar spine is highly flexible in the sagittal directions, thus, rendering it susceptible to both flexion and extension forces with the thoracolumbar junction being the most vulnerable part of it. To date, the modern thoracolumbar spine fracture classification is given by the AOSpine classification system based on the well-known Magerl classification of vertebral fracture morphology but now includes both neurological criteria and clinical modifiers, such as ankylosing spondylitis. DIAGNOSTICS Whereas plain radiography remains a mainstay in the diagnostic evaluation of low-energy trauma patients, computed tomography (CT) exhibits its unsurpassed power in polytrauma and plays a decisive role in all equivocal cases where the osseous situation is unclear. However, magnetic resonance imaging (MRI) is increasingly gaining importance for assessing both discoligamentous integrity and intraspinal condition. Both CT and MRI have direct input in classifying fractures according to the AOSpine classification. RESULTS Regarding fracture morphology, three main types (A-C) based on the stability are distinguished. C‑type spinal injuries are all considered unstable, irrespective of type and severity of vertebral malalignment. Injuries to the anterior and posterior ligamentous complex are also considered to interfere with stability (B-type injuries). CONCLUSIONS Special fracture patterns of the injured ankylosed and osteoporotic spine as well as of the pediatric lumbar spine are discussed. A survey is also given about several differential diagnoses (malignant fractures, anomalies, normal variants).
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Affiliation(s)
- Thomas Grieser
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
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21
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Zheng C, Lin X, Liu H, Lu W, Xu X, Wang D, Gao B, Wang C, Zhou J, Fan J, Hu Y, Jie Q, Chen D, Yang L, Luo Z. Phenotypic characterization of Slc26a2 mutant mice reveals a multifactorial etiology of spondylolysis. FASEB J 2019; 34:720-734. [PMID: 31914611 DOI: 10.1096/fj.201901040rr] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 10/20/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023]
Abstract
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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Affiliation(s)
- Chao Zheng
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xisheng Lin
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - He Liu
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Weiguang Lu
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaolong Xu
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Di Wang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Bo Gao
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Cheng Wang
- School of Biomedical Sciences, University of Hong Kong, Hong Kong, China
| | - Jinru Zhou
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jing Fan
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yaqian Hu
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Qiang Jie
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University, College of Medicine, Xi'an, China
| | - Di Chen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Liu Yang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Medical Research Institute, Northwestern Polytechnical University, Xi'an, China
| | - Zhuojing Luo
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Medical Research Institute, Northwestern Polytechnical University, Xi'an, China
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22
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West AM, d'Hemecourt PA, Bono OJ, Micheli LJ, Sugimoto D. Diagnostic Accuracy of Magnetic Resonance Imaging and Computed Tomography Scan in Young Athletes With Spondylolysis. Clin Pediatr (Phila) 2019; 58:671-676. [PMID: 30813766 DOI: 10.1177/0009922819832643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to determine diagnostic accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) scans in young athletes diagnosed with spondylolysis. A cross-sectional study was used. Twenty-two young athletes (14.7 ± 1.5 years) were diagnosed as spondylolysis based on a single-photon emission CT. Following the diagnosis, participants underwent MRI and CT scan imaging tests on the same day. The sensitivity and false-negative rate of the MRI and CT scans were analyzed. MRI test confirmed 13 (+) and 9 (-) results while CT test showed 17 (+) and 5 (-) results. The sensitivity and false-negative rate of MRI were, respectively, 59.1% (95% confidence interval [CI] = 36.7% to 78.5%) and 40.9% (95% CI = 21.5% to 63.3%). Furthermore, the sensitivity and false-negative rate of CT scan were 77.3% (95% CI = 54.2% to 91.3%) and 22.7% (95% CI = 0.09% to 45.8%). Our results indicated that CT scan is a more accurate imaging modality to diagnose spondylolysis compared with MRI in young athletes.
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Affiliation(s)
- Amy M West
- 1 Spaulding Rehabilitation Hospital, Boston, MA, USA.,2 Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Pierre A d'Hemecourt
- 2 Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.,3 Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston MA, USA.,4 The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | | | - Lyle J Micheli
- 2 Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.,3 Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston MA, USA.,4 The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Dai Sugimoto
- 2 Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.,3 Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston MA, USA.,4 The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
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23
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Increased Lumbar Lordosis and Smaller Vertebral Cross-Sectional Area Are Associated With Spondylolysis. Spine (Phila Pa 1976) 2018; 43:833-838. [PMID: 29095410 DOI: 10.1097/brs.0000000000002480] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional comparison of vertebral morphology and lumbar lordosis (LL) in adolescents with and without spondylolysis. OBJECTIVE To test the hypothesis that in addition to LL, vertebral cross-sectional area (CSA) is also associated with spondylolysis. SUMMARY OF BACKGROUND DATA Recent data indicate that the CSA of the vertebral body is a determinant of LL, which has been shown to be associated with spondylolysis. METHODS Using magnetic resonance imaging, we compared the degree of LL from L1 to L5 and the CSA of the lumbar vertebrae in 35 adolescents (16 females and 19 males) with spondylolysis and 86 healthy controls (36 females and 50 males) of similar sex, age, height, and weight. RESULTS There were no significant differences in age, height, weight, or vertebral height between subjects with and without spondylolysis, regardless of sex. In contrast, LL angle in spondylolysis patients was 57% and 51% greater in girls and boys with spondylolysis; 44.1 ± 10.4° versus 28.1 ± 9.8° and 34.8 ± 5.9° versus 23.0 ± 6.0° for girls and boys, respectively (both P's < 0.0001). Additionally, values for vertebral CSA were on average, 8% and 10% smaller in females and males with spondylolysis; 7.6 ± 0.8 cmversus 8.3 ± 1.1 cm and 8.4 ± 1.6 versus 9.3 ± 1.6 for girls and boys, respectively (both P's ≤ 0.039). Multiple linear and logistic regression analyses indicated that the CSA of the vertebral body was negatively associated with LL angle and an independent predictor of the presence of spondylolysis. This was true regardless of whether girls and boys were analyzed together or independently, and whether LL angle was measured from L1 to L5 or S1. CONCLUSION We provide evidence that patients with spondylolysis have increased LL and smaller vertebral CSA. LEVEL OF EVIDENCE 4.
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Gilsanz V, Wren TAL, Ponrartana S, Mora S, Rosen CJ. Sexual Dimorphism and the Origins of Human Spinal Health. Endocr Rev 2018; 39:221-239. [PMID: 29385433 PMCID: PMC5888211 DOI: 10.1210/er.2017-00147] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/24/2018] [Indexed: 12/26/2022]
Abstract
Recent observations indicate that the cross-sectional area (CSA) of vertebral bodies is on average 10% smaller in healthy newborn girls than in newborn boys, a striking difference that increases during infancy and puberty and is greatest by the time of sexual and skeletal maturity. The smaller CSA of female vertebrae is associated with greater spinal flexibility and could represent the human adaptation to fetal load in bipedal posture. Unfortunately, it also imparts a mechanical disadvantage that increases stress within the vertebrae for all physical activities. This review summarizes the potential endocrine, genetic, and environmental determinants of vertebral cross-sectional growth and current knowledge of the association between the small female vertebrae and greater risk for a broad array of spinal conditions across the lifespan.
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Affiliation(s)
- Vicente Gilsanz
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027.,Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027.,Department of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027
| | - Tishya A L Wren
- Department of Orthopaedic Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027
| | - Skorn Ponrartana
- Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Clifford J Rosen
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, Maine 04074
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Tsuboi H, Nishimura Y, Sakata T, Tanina H, Arakawa H, Nakamura T, Umezu Y, Tajima F. Properties of Paraspinal Muscles in Japanese High School Baseball Players With Terminal-Stage Lumbar Spondylolysis. PM R 2017; 10:175-182. [DOI: 10.1016/j.pmrj.2017.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 05/18/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
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Vernese LF, Chu SK. Spondylolysis: Assessment and Treatment in Youth Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Thornton JS, Vinther A, Wilson F, Lebrun CM, Wilkinson M, Di Ciacca SR, Orlando K, Smoljanovic T. Rowing Injuries: An Updated Review. Sports Med 2016; 47:641-661. [DOI: 10.1007/s40279-016-0613-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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