An aetiological study on spondylolysis from a biomechanical aspect

Prevalence and Risk Factors of Musculoskeletal Disorders in Basketball Players: Systematic Review and Meta-Analysis

Musculoskeletal disorders characteristically induce pain and limitations in mobility, ability, and overall functioning. In athletes, including basketball players, disorders such as back pain, postural changes, and spinal injuries are common. This systematic review aimed to evaluate the prevalence of back pain and musculoskeletal disorders in basketball players and ascertain the associated factors. Methods: The Embase, PubMed, and Scopus databases were searched for studies published in English without a time limit. Using STATA, meta-analyses were performed to estimate the prevalence of pain and musculoskeletal disorders of the back and spine. Results: Of the 4135 articles identified, 33 studies were included in this review, with 27 studies included in the meta-analysis. Of these, 21 were used for the meta-analysis of back pain, 6 articles were used for the meta-analysis of spinal injury, and 2 studies were used for the meta-analysis of postural changes. The overall prevalence of back pain was 43% [95% CI, -1% to 88%]; of these, the prevalence of neck pain was 36% [95% CI, 22-50%], the prevalence of back pain was 16% [95% CI, 4-28%], the prevalence of low back pain was 26% [95% CI, 16-37%], the prevalence of thoracic spine pain was 6% [95% CI, 3-9%]. The combined prevalence of spinal injury and spondylolysis was 10% [95% CI, 4-15%], with a prevalence of spondylolysis of 14% [95% CI, 0.1-27%]. The combined prevalence of hyperkyphosis and hyperlordosis was 30% [95% CI, 9-51%]. In conclusion, we found a high prevalence of neck pain, followed by low back pain and back pain, in basketball players. Thus, prevention programs are important to improve health and sports performance.

The association between occupational loading and spine degeneration on imaging - a systematic review and meta-analysis

Background

There are inconsistencies in findings regarding the relationship of occupational loading with spinal degeneration or structural damage. Thus, a systematic review was conducted to determine the current state of knowledge on the association of occupational loading and spine degeneration on imaging.

Methods

We performed electronic searches on MEDLINE, CINAHL and EMBASE. We included cross-sectional, case control and cohort studies evaluating occupational loading as the exposure and lumbar spine structural findings on imaging as the outcomes. When possible, results were pooled.

Results

Seventeen studies were included in the review. Ten studies evaluated the association of occupational loading with disc degeneration (signal intensity), four of which were pooled into a meta-analysis. Of the 10 studies, only two did not identify a relationship between occupation loading and disc degeneration. A meta-analysis including four of the studies demonstrated an association between higher loading and degeneration for all spinal levels, with odds ratios between 1.6 and 3.3. Seven studies evaluated disc height narrowing and seven evaluate disc bulge, with six and five identifying an association of loading and with imaging findings respectively. Three studies evaluated modic changes and one identified and association with occupational load.

Conclusions

There was moderate evidence suggesting a modest association between occupational loading and disc degeneration (signal intensity), and low-quality evidence of an association between occupational loading and disc narrowing and bulging.

Low back pain in female elite football and handball players compared with an active control group

PURPOSE

The purpose of this cross-sectional study was to compare the prevalence of low back pain (LBP) among female elite football and handball players to a matched non-professional active control group.

METHODS

The participants were requested to answer a questionnaire based on standardized Nordic questionnaires for musculoskeletal symptoms to assess the prevalence of LBP. Included participants were elite female football (n = 277) and handball players (n = 190), and a randomly selected control group from the Norwegian population (n = 167).

RESULTS

Fifty-seven percentage of the football players, 59 % of the handball players and 60 % of the control group had experienced LBP the previous year. There were no significant group differences in the prevalence of LBP ever (p = 0.62), the previous year (p = 0.85) or the previous 7 days (p = 0.63). For both sports, there was a significant increase in prevalence of LBP from the resting period to the competitive periods of the season (p ≤ 0.001). Seventy percent of the goalkeepers in both football and handball had experienced LBP the previous year.

CONCLUSION

There were no difference in LBP among female elite football and handball players compared with the control group. However, female elite athletes in football and handball reported a high prevalence of LBP compared to previous studies. The variations in LBP and playing positions indicate that specific field positions, in football and handball, is a risk factor for developing LBP.

A biomechanical comparison of three spondylolysis repair techniques in a calf spine model

SUMMARY OF BACKGROUND DATA

Previous work has demonstrated the efficacy of lumbar pedicle screw hook rod (PSHR) techniques and the Buck screw in the stabilization of spondylolysis. The mechanical behavior of lower profile cervical implants used to create PSHR, hybrid cable plate constructs, and titanium miniplating has not previously been described.

METHODS

Calf lumbar spines (L2-L6) were utilized for testing (n=27). Intervertebral rotation was measured in the intact spines across the L4-5 segment before and after creation of bilateral pars interarticularis defects. Defects were then stabilized with one of three repair techniques, PSHR, miniplate, or cable plate (CP) constructs. (n=9). A 5-Nm load was applied in flexion-extension, lateral bending and axial rotation. Fracture displacement was measured under flexion-extension and lateral bending modes.

RESULTS

Osteotomy of the pars interarticularis increased intervertebral rotation from 4.6° to 9.2° (P<.05). The three techniques of repair reduced intervertebral rotation without statistical superiority of one method. In lateral bending the miniplate was most effective in reducing pars defect displacement (0.6mm, P<0.05). Although, the miniplate provided lower defect displacement in flexion-extension and axial rotation, these differences were not statistically significant.

CONCLUSIONS

Bilateral miniplate fixation demonstrates superiority in restoring stability in lateral bending as compared to pedicle screw hook rod techniques and cable plate constructs. In flexion-extension and axial rotation, it was as effective as a PSHR method. Consideration of anatomic plate designs warrants consideration.

LEVEL OF EVIDENCE

IV.

Spondylolysis in young tennis players

The general aetiology, diagnosis, and treatment of spondylolysis, a bone defect in the pars interarticularis of the vertebra, are reviewed. A retrospective study of young tennis players diagnosed between 2000 and 2004 with spondylolysis with or without spondylolisthesis, assessed by radiography and planar bone scintigraphy, is described. If the radiographic results were negative, computed tomography was performed. Sixty six cases were evaluated: 53 L5 lesions, eight L4 lesions, two L3 lesions, and one bilateral lesion at the L2 level. Two more lesions at two levels were found (bilateral L5 and unilateral L4 and L3 on the right side). Classification, treatment, and outcome of the cases are reported. A combination of radiography, planar bone scintigraphy, and SPECT is useful for evaluating spondylolysis in tennis players and recommending treatment. Use of a brace did not appear to achieve significant results.

Degenerative disease in lumbar spine of military parachuting instructors

Parachuting, be it static line or skydiving, places enormous stresses on the human spine. It is, therefore, important to determine the prevalence and severity of degenerative changes in the lumbar spine of subjects who practice this sport activity. Seventy four parachuting instructors, mean age 33 years and with an average of 410 static line and skydiving jumps, were included in the study. Past radiographs were examined and compared to current anterolateral and lateral views of the lumbar spine, in order to determine the prevalence of degenerative changes and document possible progression. Doubtful radiographic changes in the lumbar spine were identified in 47.4 percent of the parachuting instructors, mild degeneration in 9.6 percent, moderate degenerative disease in 10.9 percent and severe radiographic changes in 5.5 percent. Schmorll nodes were found in 8.1 percent of the subjects. Traction spurs--osteophytes were identified in 6.8 percent. The degenerative changes correlated with age and the number of jumps. Spondylolysis of L5-S1 and L3-L4 segments were observed in 12.2 and 1.4 percent respectively. Progressive spondylolisthesis was found in 2 subjects. No correlation was found between the severity of radiographic changes and either the prevalence and the severity of low back pain. The present findings provide a rational for considering repeated sheer stress as an etiology of degenerative changes in the spinal cord, and as a possible contributing factor to the pathogenesis of spondylolysis. Further study has to be done comparing parachuting instructors to a non-parachuting group, or equivalent physically active individuals, in order to assess the effect of sport-background on the development of degenerative changes.

A biomechanical study of lumbar spondylolysis based on a three-dimensional finite element method

Biomechanical analyses under compression only, and for a combination of flexion, extension, rotation, and lateral bending were performed to evaluate the stress of the interarticular portion of the lumbar vertebra using a nonlinear three-dimensional finite element method. A detailed three-dimensional L4-L5 motion segment model was developed that took into consideration the material nonlinearities of ligaments and annular fibers and the contact nonlinearities of facet joints. For a more accurate examination, the separation of cortical bone and cancellous bone for both posterior and anterior elements were also considered. The stress in the pars interarticularis was weakest under compression alone, but stronger under compression with lateral bending loading, with flexion, with rotation, and with extension. Under each loading condition, the region of the stress concentration was consistent with the separated region of the spondylolysis observed in clinical situations. Since the stress in the pars interarticularis was high under extension and rotation in particular, those loadings were suggested to be relatively high risk factors leading to spondylolysis.

Back pain in former intercollegiate rowers. A long-term follow-up study

BACKGROUND

Research has shown that 32% of intercollegiate rowers develop back pain during their college career.

HYPOTHESIS

Rowers who develop back pain in college are more likely than the general population to have back pain later in life.

STUDY DESIGN

Survey.

METHODS

Surveys from 1561 former intercollegiate rowing athletes were analyzed. Subjects who completed the surveys had graduated from college at a mean and median of 13 years previously, with a range of 0 to 20 years between graduation and completion of the survey. The survey was designed to determine the presence of back pain and its severity before, during, and after intercollegiate rowing. Back pain was defined as pain that lasted at least 1 week.

RESULTS

Age was a significant predictor of back pain after college. Nevertheless, the lifetime prevalence of back pain in former intercollegiate rowers was no different from that of the general population (51.4% versus 60% to 80%). However, rowers who developed back pain in college had more subsequent back pain than rowers who were asymptomatic in college (78.9% versus 37.9%). Rowers who were asymptomatic in college had significantly lower rates of back pain as they aged than did the general population. The mean severity of current back pain was 3.5 +/- 1.9 on a scale of 1 to 10.

CONCLUSIONS

Intercollegiate rowers are no more likely than the general population to have back pain later in life.

Back pain in intercollegiate rowers

BACKGROUND

Back pain is prevalent among intercollegiate rowers.

PURPOSE

We conducted a large-scale study to determine the rate of and the potential etiologic factors for clearly defined back pain that developed during intercollegiate rowing.

STUDY DESIGN

Survey.

METHODS

Surveys from 1632 former intercollegiate rowing athletes were analyzed. These surveys concerned training methods and back pain before and during intercollegiate rowing. Back pain was defined as pain that lasted at least 1 week.

RESULTS

Five hundred twenty-six subjects reported that back pain developed during intercollegiate rowing. Factors significantly associated with the development of back pain included age at the time of the survey; history of rowing before age 16; use of a hatchet oar blade; training with free weights, weight machines, and an ergometer; midline ergometer cable position; and ergometer training sessions longer than 30 minutes. Back pain while in college also was associated with higher mean college weight and height.

CONCLUSIONS

Intercollegiate rowers in the last 10 years covered by this study were larger, started rowing at an earlier age, trained more intensely, and developed more back pain during college than their predecessors.

Sacral osseous destruction in a female gymnast: unusual manifestation of Scheuermann's disease?

We describe a 14-year-old female gymnast whose complaint was that of chronic low back pain. Radiographs and computed tomograms showed both lumbar manifestations of Scheuermann's disease and an osseous destruction of the S1 vertebral body. We suggest that this is a sacral component of Scheuermann's disease.

Spondylolysis and spondylolisthesis

Lysis is common and its causes are mainly constitutional. Most of slipping has already occurred when the patient comes for consultation. A further progress is often caused by disc pathology. Neurological deficits are rare. A high-degree olisthesis and L4 location are risk factors for future back pain. Asymptomatic lysis with or without olisthesis should not be treated. A posterolateral fusion in situ without instrumentation gives good results in adolescents and young adults, whereas old patients benefit from instrumentation. Reduction cannot be recommended as a routine method.

Injuries in women's gymnastics. The state of the art

This article takes a three-stage approach to the topic of injuries in women's gymnastics. In the first stage, we review the literature and summarize our current knowledge of injury rates, injuries in specific events, and anatomical location of injuries. In the second, we critically evaluate the relative contributions of these studies in terms of their generalizability, methods, and conceptual approaches. Finally, we present possible directions for future research in the area of women's gymnastic injuries.

The etiology of spondylolysis. A retrospective radiographic study

One hundred and thirty-five patients with lysis in the fifth (lowest) lumbar vertebra and 24 patients with L4 lysis were compared retrospectively with respect to radiographic variables and the occurrence of trauma before symptom onset. Hypoplasia occurred only in the L5 lysis group, whereas trauma as a symptom-precipitating factor was frequent in the L4 group. These observations suggest the possibility of different etiologies: trauma may contribute to lysis in a normal L4 vertebra, and inherited hypoplasia of the lumbosacral junction may lead to L5 lysis.

Jogger's fracture and other stress fractures of the lumbo-sacral spine

The posterior rings of the lower lumbo-sacral vertebrae are subject to stress fractures at any part - pedicle, pars, or lamina. The site of fracture is apparently determined by the axis of weight bearing. The three illustrative clinical examples cited include a jogger with a laminar fracture, a ballet dancer with pedicle fractures, and a nine-year-old boy with fractures of pars and lamina. Chronic low back pain is the typical complaint with stress fractures of the lower lumbo-sacral spine. Special imaging techniques are usually needed to demonstrate these lesions, including vertebral arch views, multi-directional tomography, and computed tomography (CT).