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Nakashima H, Yoneda M, Machino M, Ito S, Segi N, Tomita H, Ouchida J, Imagama S. Utility of ultrasonography in the diagnosis of lumbar spondylolysis in adolescent patients. J Orthop Sci 2023; 28:955-960. [PMID: 35864027 DOI: 10.1016/j.jos.2022.06.019] [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: 05/06/2022] [Revised: 06/01/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aims to investigate the utility of the Doppler effect on ultrasonography for the diagnosis of very early- and early-stage lumbar spondylolysis in adolescent patients. METHODS In total, 76 adolescent patients with acute and subacute low back pain were prospectively enrolled, with 46 having lumbar spondylolysis and the remaining 30 having low back pain without spondylolysis. MRI and/or computed tomograms scans revealed very early- and early-stage lumbar spondylolysis. Furthermore, positive Doppler findings in ultrasonography around the area from the facet joint to the laminae were investigated. RESULTS There were no significant differences in age (p > 0.99) and body mass index (p = 0.11) between cases with and without spondylolysis. Very early- and early-stage spondylolysis were observed in 27.6% and 72.4% of patients, respectively. Positive power Doppler was 91.3% and 33.3% in cases with and without spondylolysis, respectively, which was significantly higher in spondylolysis (p < 0.001). The sensitivity and specificity of this positive power Doppler were 91.4% and 66.7%, respectively. Furthermore, the rate of positive power Doppler was significantly higher in early-stage spondylolysis (p = 0.02), with 75.0% and 97.6% sensitivity in very early- and early-stage spondylolysis, respectively. CONCLUSIONS A positive Doppler effect on ultrasonography is effective for screening very early- and early-stage spondylolysis in adolescent patients in an outpatient clinic.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan; Department of Orthopedic Surgery, Yoneda Hospital, Japan.
| | - Minoru Yoneda
- Department of Orthopedic Surgery, Yoneda Hospital, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Hiroyuki Tomita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Jun Ouchida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
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Peterson E, Finkel J. Trigger point injections for axial back pain in adolescents. BMJ Case Rep 2021; 14:e242727. [PMID: 34167984 PMCID: PMC8231043 DOI: 10.1136/bcr-2021-242727] [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] [Accepted: 06/08/2021] [Indexed: 11/04/2022] Open
Abstract
Adolescents who participate in athletics or have abnormal musculoskeletal anatomy have higher incidences of back pain than non-athletic peers with normal anatomy. Significant time and money spent in diagnostic evaluations for axial back pain can result in treatment delay causing a subsequent decrease in quality of life. Myofascial trigger points are a commonly overlooked reason for axial back pain. They develop due to an abnormal myoneural connection in the setting of muscle overuse. Trigger point injections are a technically simple intervention that is both diagnostic and therapeutic in alleviating trigger point-mediated back pain. There are few complications from these injections, and they should be considered prior to surgical referral or fluoroscopic-guided interventions.
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Affiliation(s)
- Elisha Peterson
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
- Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Julia Finkel
- Pain Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation; Children's National Hospital, Pediatrics and Critical Care Medicine, The George Washington University, Washington, District of Columbia, USA
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Cuenca C, Bataille J, Ghouilem M, Ballouhey Q, Fourcade L, Marcheix PS. Bertolotti's syndrome in children: From low-back pain to surgery. A case report. Neurochirurgie 2019; 65:421-424. [DOI: 10.1016/j.neuchi.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/09/2019] [Accepted: 06/22/2019] [Indexed: 10/26/2022]
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Abstract
When searching for evidence-based answers about treating athletes with low back injury/pain, there are some difficulties. The first is defining who is an athlete. The second problem is that the lifetime prevalence of low back pain in the general population in our country approaches 100. Last, most studies published only deal with a narrow population of athletes, often performing very different types of physical activity. We searched the literature for studies that specifically evaluated athletes longitudinally. This article reviews the demographics, diagnostic challenges, history and physical examination, imaging choices, treatment, and controversies encountered when treating this population.
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Affiliation(s)
- James M Daniels
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, 612 North 11th Street, Quincy, IL 62301, USA.
| | - Cesar Arguelles
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, 612 North 11th Street, Quincy, IL 62301, USA
| | - Christopher Gleason
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, 520 North 4th Street, Springfield, IL 62702, USA
| | - William H Dixon
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, 612 North 11th Street, Quincy, IL 62301, USA
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Moley PJ, Gribbin CK, Vargas E, Kelly BT. Co-diagnoses of spondylolysis and femoroacetabular impingement: a case series of adolescent athletes. J Hip Preserv Surg 2018; 5:393-398. [PMID: 30647930 PMCID: PMC6328847 DOI: 10.1093/jhps/hny040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 09/10/2018] [Accepted: 10/20/2018] [Indexed: 12/27/2022] Open
Abstract
Locating the source of lumbopelvic–hip pain requires the consideration of multiple clinical pathways. Although low back pain has an incidence of 50% in the adolescent population, the pathophysiology in this population typically differs from that of other age groups. Dynamic mechanical impairments of the hip, such as femoroacetabular impingement, may contribute to the pathogenesis of adolescent low back pain. Eight adolescent male athletes who presented to a single provider with a primary complaint of low back pain with hip pain or motion loss on exam and were ultimately diagnosed with lumbar spondylolysis and dynamic mechanical hip issues between 2009 and 2011 were included. The age at spondylolysis diagnosis ranged from 15 to 19 years (mean ± standard deviation: 16.3 ± 1.3 years). Seven patients had cam-type impingement, whereas one presented with pincer-type impingement. All patients demonstrated either decreased internal rotation at 90 degrees of hip flexion and neutral abduction or pain on the Flexion Adduction Internal Rotation test on at least one of hip. All eight patients were treated initially with 6 weeks of physical therapy consisting of attempted restoration of hip motion and the graduated progression of hip and spine stabilization exercises. Five patients (62.5%) returned to sport at an average of 11.2 weeks (range: 6–16 weeks). For three patients (37.5%), hip pain and motion loss persisted, thus requiring surgery. All subjects had symptoms for at least 6 weeks, with 6 months as the longest duration. This report is the first documented series of adolescent athletes with co-diagnoses of spondylolysis and femoroacetabular impingement. Study Information: This retrospective case series was approved by the Institutional Review Board at Hospital for Special Surgery.
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Affiliation(s)
- Peter J Moley
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Caitlin K Gribbin
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Elizabeth Vargas
- Department of Physiatry, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Bryan T Kelly
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
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Kapetanakis S, Chaniotakis C, Paraskevopoulos C, Pavlidis P. An Unusual Case Report of Bertolotti's Syndrome: Extraforaminal Stenosis and L5 Unilateral Root Compression (Castellvi Type III an LSTV). J Orthop Case Rep 2017; 7:9-12. [PMID: 29051870 PMCID: PMC5635197 DOI: 10.13107/jocr.2250-0685.782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Castellvi Type III lumbosacral transitional vertebrae (LSTV) is an unusual case of Bertolotti’s syndrome (BS) due to extraforaminal stenosis, especially manifesting in elderly patients. Case Report: We report a case of BS in a 62 years old Greek female. The signs of the clinical examination are low back pain, sciatica, hypoesthesia, and pain to the contribution of L5 nerve. Imaging techniques revealed an LSTV Type III a (complete sacralization between LSTV and sacrum). Conclusion: Despite the fact that LSTV is a congenital lesion, the clinical manifestation of BS may present in the elderly population. The accumulative effect of the gradual degeneration of intervertebral foramen (stenosis) may lead to the compression of extraforaminal portion of the nerve root.
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Affiliation(s)
- Stylianos Kapetanakis
- Department of Spine and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | | | - Pavlos Pavlidis
- Laboratory of Forensic Sciences, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Noll M, Silveira EA, de Avelar IS. Evaluation of factors associated with severe and frequent back pain in high school athletes. PLoS One 2017; 12:e0171978. [PMID: 28222141 PMCID: PMC5319774 DOI: 10.1371/journal.pone.0171978] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/30/2017] [Indexed: 01/09/2023] Open
Abstract
Several studies have shown that half of all young athletes experience back pain (BP). However, high intensity and frequency of BP may be harmful, and the factors associated with BP severity have not been investigated in detail. Here, we investigated the factors associated with a high intensity and high frequency of BP in high school athletes. We included 251 athletes (173 boys and 78 girls [14-20 years old]) in this cross-sectional study. The dependent variables were a high frequency and high intensity of BP, and the independent variables were demographic, socioeconomic, psychosocial, hereditary, anthropometric, behavioural, and postural factors and the level of exercise. The effect measure is presented as prevalence ratio (PR) with 95% confidence interval (CI). Of 251 athletes, 104 reported BP; thus, only these athletes were included in the present analysis. Results of multivariable analysis showed an association between high BP intensity and time spent using a computer (PR: 1.15, CI: 1.01-1.33), posture while writing (PR: 1.41, CI: 1.27-1.58), and posture while using a computer (PR: 1.39, CI: 1.26-1.54). Multivariable analysis also revealed an association of high BP frequency with studying in bed (PR: 1.19, CI: 1.01-1.40) and the method of carrying a backpack (PR: 1.19, CI: 1.01-1.40). In conclusion, we found that behavioural and postural factors are associated with a high intensity and frequency of BP. To the best of our knowledge, this study is the first to compare different intensities and frequencies of BP, and our results may help physicians and coaches to better understand BP in high school athletes.
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Affiliation(s)
- Matias Noll
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiás, Brazil
- Instituto Federal Goiano, Goiás, Brazil
| | - Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiás, Brazil
| | - Ivan Silveira de Avelar
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiás, Brazil
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Solomon ML, Briskin SM, Sabatina N, Steinhoff JE. The Pediatric Endurance Athlete. Curr Sports Med Rep 2017; 16:428-434. [DOI: 10.1249/jsr.0000000000000428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Panteliadis P, Nagra NS, Edwards KL, Behrbalk E, Boszczyk B. Athletic Population with Spondylolysis: Review of Outcomes following Surgical Repair or Conservative Management. Global Spine J 2016; 6:615-25. [PMID: 27556003 PMCID: PMC4993622 DOI: 10.1055/s-0036-1586743] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 06/27/2016] [Indexed: 01/13/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE The study aims to critically review the outcomes associated with the surgical repair or conservative management of spondylolysis in athletes. METHODS The English literature listed in MEDLINE/PubMed was reviewed to identify related articles using the term "spondylolysis AND athlete." The criteria for studies to be included were management of spondylolysis in athletes, English text, and no year, follow-up, or study design restrictions. The references of the retrieved articles were also evaluated. The primary outcome was time to return to sport. This search yielded 180 citations, and 25 publications were included in the review. RESULTS Treatment methods were dichotomized as operative and nonoperative. In the nonoperative group, 390 athletes were included. A combination of bracing with physical therapy and restriction of activities was used. Conservative measures allowed athletes to return to sport in 3.7 months (weighted mean). One hundred seventy-four patients were treated surgically. The most common technique was Buck's, using a compression screw (91/174). All authors reported satisfactory outcomes. Time to return to play was 7.9 months (weighted mean). There were insufficient studies with suitably homogenous subgroups to conduct a meta-analysis. CONCLUSION There is no gold standard approach for the management of spondylolysis in the athletic population. The existing literature suggests initial therapy should be a course of conservative management with thoracolumbosacral orthosis brace, physiotherapy, and activity modification. If conservative management fails, surgical intervention should be considered. Two-sided clinical studies are needed to determine an optimal pathway for the management of athletes with spondylolysis.
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Affiliation(s)
- Pavlos Panteliadis
- Spinal Department, Oxford University Hospitals, Headley Way, Oxford, United Kingdom,Address for correspondence Pavlos Panteliadis, MD Spinal Department, Oxford University HospitalsHeadley Way, Oxford OX3 9DUUnited Kingdom
| | - Navraj S. Nagra
- Orthopaedic Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, United Kingdom,Division of Medical Sciences, Oxford University Clinical Academic Graduate School, Headley Way, Oxford, United Kingdom
| | | | - Eyal Behrbalk
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Bronek Boszczyk
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
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