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Wall J, Cook DL, Meehan WP, Wilson F. Adolescent athlete low back pain diagnoses, characteristics, and management: A retrospective chart review. J Sci Med Sport 2024:S1440-2440(24)00153-1. [PMID: 38981776 DOI: 10.1016/j.jsams.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/27/2024] [Accepted: 05/14/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES The aim of this study was to characterise the presentation, treatment, and management of adolescent athlete low back pain (LBP) as diagnosed in a clinical setting. The objectives were to 1) identify diagnoses associated with LBP in adolescent athletes; 2) categorise the differences in LBP diagnosis and presentation by sport, sex, BMI, and age; and 3) examine treatment and management methods of LBP in adolescent athletes. DESIGN Retrospective chart review. METHODS This retrospective medical chart review was conducted in the Sports Medicine Division of Boston Children's Hospital (BCH), a tertiary paediatric academic hospital. Data were collected and analysed from 363 adolescent athletes who had experienced LBP between 2015 and 2020. Chi-squared tests for association were used to assess for associations between LBP diagnoses and age, sex, BMI, and sport. Statistical analysis was conducted using SAS software version 9.4 (SAS Institute, Cary NC). RESULTS Non-specific LBP was the most common LBP diagnosis amongst 363 adolescent athletes with LBP (34 %). This was closely followed by spondylolysis (28 %). There was a higher proportion of female athletes amongst participants diagnosed with facet-joint related pain (90 %) and SI-joint related pain (89 %) compared to the proportion of female athletes amongst participants diagnosed with spondylolysis (50 %). There was a high rate of diagnostic MRI usage in this cohort. Commonly used management techniques in this cohort were diagnostic MRI, physical therapy, relative rest, and bracing. CONCLUSIONS An awareness of the sex-based differences in adolescent athlete LBP diagnoses may be useful for clinicians. It may be important to refine methods of diagnosis of LBP in this group, as there was a high rate of diagnostic MRI use. Future research should be directed towards the development of management guidelines specific to LBP in adolescent athletes to assist in the optimal management of this diagnosis.
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Affiliation(s)
- Julia Wall
- Trinity College Dublin Discipline of Physiotherapy, Ireland.
| | - Danielle L Cook
- Boston Children's Hospital Division of Sports Medicine, United States of America
| | - William P Meehan
- Boston Children's Hospital Division of Sports Medicine, United States of America
| | - Fiona Wilson
- Trinity College Dublin Discipline of Physiotherapy, Ireland. https://twitter.com/FionaWilsonf
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Ekhator C, Bellegarde SB, Nduma BN, Qureshi MQ, Fonkem E. The Spine is the Tree of Life: A Systematic Review and Meta-Analysis of the Radiographic Findings Related to Spinal Injuries in Athletes. Cureus 2024; 16:e58780. [PMID: 38784300 PMCID: PMC11111419 DOI: 10.7759/cureus.58780] [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] [Accepted: 04/12/2024] [Indexed: 05/25/2024] Open
Abstract
This review article explores spinal injuries in athletes participating in various sporting activities. It also highlights the various mechanisms of injuries that contribute to spinal injuries in each sport. Electronic databases such as PubMed, Cochrane Library, Web of Science, Embase, MEDLINE Ovid, and Google Scholar were searched for articles from 2000 to 2022 on spine injuries in sports and radiological studies discussing the various injury patterns among athletes. Studies were scoured in accordance with the inclusion criteria, and relevant data such as the number of participants, sporting activities, spine injuries, and outcomes were retrieved. Fifteen articles that met the inclusion criteria were included in the study. Cervical spine injuries are common in athletes who participate in contact sports such as football. Similarly, athletes in collision sports such as football, rugby, and hockey are likely to suffer stingers due to traction and compression injuries. Players engaged in such as soccer, baseball, and swimming, are likely to suffer from spondylolysis. Soccer players are more prone to multiple lesions compared to athletes in sports such as baseball because the sport involves training exercises such as jogging and running without kicking any ball. In swimmers, spondylolysis is common in breaststroke and butterfly styles since they involve repeated flexion and hyperextension of the lumbar spine. CT is essential for diagnosing spondylolysis as it demonstrates the lesions more accurately. Ice hockey is associated with a significant incidence of cervical spine injuries, mostly due to players being constantly checked/pushed from behind. Spine injuries are common in elite athletes across several sports. About 10% of spinal injuries in the United States result from sports activities. In diagnosing spine injuries, imaging modalities such as MRI, CT, or plain radiographs are essential. From a radiologist's perspective, these tests help immensely in deciding which treatment is required for a particular athlete or how the injury can be optimally managed. Achieving recovery from a specific spine injury usually depends on the kind of injury and the rehabilitation process the athletes undergo before returning to play.
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Affiliation(s)
- Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, USA
| | - Sophia B Bellegarde
- Pathology and Laboratory Medicine, American University of Antigua, St. John's, ATG
| | - Basil N Nduma
- Internal Medicine, Medical City Hospital, Denton, USA
| | | | - Ekokobe Fonkem
- Neuro-Oncology, Barrow Neurological Institute, Phoenix, USA
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3
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Lafuente J, Patino JD, Capo L. Management of Low and High Grades Spondylolisthesis. Adv Tech Stand Neurosurg 2024; 49:51-72. [PMID: 38700680 DOI: 10.1007/978-3-031-42398-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Spondylolisthesis is defined as the displacement or misalignment of the vertebral bodies one on top of the other. It comes from the Greek spondlylos, which means vertebra, and olisthesis, which means sliding on a slope. The nomenclature used to refer to spondylolisthesis consists of the following elements: vertebral segment (vertebrae involved), degree of sliding of one vertebral body over the other, the position of the upper vertebral body with respect to the lower one (anterolisthesis/retrolisthesis), and finally the etiology [1].
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Affiliation(s)
- Jesus Lafuente
- Associate Profedsor Neurosurgery, Director Spine center Hospital del Mar, Barcelona, Spain
| | | | - Lucas Capo
- Fellow Neurosurgeon Hospital de Sant Pau, Barcelona, Spain
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Cetik RM, Latalski M, Yazici M. Management of low back pain accompanying sagittal plane pathologies in children: Spondylolysis/spondylolisthesis and Scheuermann's disease. J Child Orthop 2023; 17:535-547. [PMID: 38050599 PMCID: PMC10693848 DOI: 10.1177/18632521231215873] [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: 08/01/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Background Low back pain in childhood was underappreciated for a long time, but recent studies report higher prevalences, up to 70%. Two of the common causes are spondylolyis/spondylolisthesis and Scheuermann's disease. These disorders are relevant in a way they both cause significant back pain, and may disrupt the sagittal spinal balance. Purpose To present the current evidence on the diagnosis, natural history and treatment of these disorders with a special focus on sagittal spinal alignment. Methods This study is conducted as a literature review. Results and Conclusions Spondylolysis and low-grade spondylolisthesis have a benign course and are typically treated conservatively. When pars repair is indicated, pedicle screw-based techniques achieve more than 90% fusion with acceptable complication rates. High-grade spondylolisthesis, however, is frequently progressive. Surgical treatment involves fusion, which can be done in situ or after reduction. Reduction is useful for "unbalanced" patients to acquire sagittal spinopelvic balance, and it is important to distinguish these patients. Despite lowering the risk for pseudoarthrosis, reduction brings a risk for neurologic complications. With re-operation rates as high as 40%, these patients definitely require careful preoperative planning. Scheuermann's disease generally causes back pain in addition to cosmetic discomfort during adolescence. If the kyphosis is lower than 60°, symptoms typically resolve into adulthood with conservative measures only. However, it must be kept in mind that these patients may experience problems with physical performance and have a lower quality of life even when the problem seems to have "resolved". Severe kyphosis and intractable back pain are the most frequently referred surgical indications, and surgery typically involves fusion. Proper utilization of osteotomies and proper selection of the upper and lower fusion levels are of utmost importance to prevent complications in these patients.
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Affiliation(s)
- Riza Mert Cetik
- Department of Orthopedics and Traumatology, Pursaklar State Hospital, Ankara, Turkey
| | - Michał Latalski
- Children’s Orthopedics Department, Medical University of Lublin, Lublin, Poland
| | - Muharrem Yazici
- Department of Orthopedics and Traumatology, Hacettepe University Hospitals, Ankara, Turkey
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5
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Bell AJ, Nunnerley JL, Shackel DF, Coates MH, Campbell RG, Frampton CM, Schouten R. Is MRI screening for bone marrow oedema useful in predicting lumbar bone stress injuries in adult male professional cricketers? A New Zealand pilot study. J Sci Med Sport 2023; 26:410-414. [PMID: 37541867 DOI: 10.1016/j.jsams.2023.06.013] [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: 11/26/2022] [Revised: 04/29/2023] [Accepted: 06/28/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVES The aims were to (1) prospectively observe the incidence of bone marrow oedema in asymptomatic adult male domestic professional cricketers during a season and evaluate its relationship to the development of lumbar bone stress injury and (2) further understand the practicalities of implementing a Magnetic Resonance Imaging-based screening program to prevent lumbar bone stress injury in New Zealand cricket. DESIGN Prospective observational cohort. METHODS Adult male pace bowlers received 6-weekly pre-planned Magnetic Resonance Imaging scans over a single season to determine the presence and intensity of bone marrow oedema in the posterior vertebral arches of the lumbar spine. The participants bowling volume and back pain levels were monitored prospectively. RESULTS 22 participants (mean age 25.3 years (range 20-32 years)) completed all 4 scans. Ten participants had a prior history of lumbar bone stress injury. Ten participants (45 %, 95 % confidence interval 24-68 %) had bone marrow oedema evident on at least one scan, with 9 (41 %) participants recording a bone marrow oedema intensity ≥ 2 and 5 (23 %) participants demonstrated an intensity ≥ 3. During the study one participant was diagnosed with a lumbar bone stress reaction. No participants developed a lumbar bone stress fracture. CONCLUSIONS Due to the lower incidence of lumbar bone stress injuries in adult bowlers coupled with uncertainty over appropriate threshold values for bone marrow oedema intensity, implementation of a resource intense screening program aimed at identifying adult domestic cricketers at risk of developing a lumbar bone stress injury is not currently supported.
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Affiliation(s)
| | - Joanne L Nunnerley
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Burwood Academy, New Zealand
| | | | | | | | - Chris M Frampton
- Department of Public Health and General Practice, University of Otago, New Zealand
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Silva A, Sincari M, Peixoto I, Vaz M, Mendes E. Isthmic Spondylolisthesis in Young Gymnasts: A Report of Two Cases. Cureus 2023; 15:e35152. [PMID: 36950005 PMCID: PMC10027424 DOI: 10.7759/cureus.35152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/20/2023] Open
Abstract
Isthmic spondylolisthesis is a condition characterized by the subluxation of one vertebral body over the adjacent inferior vertebral body, secondary to a defect in the pars interarticularis. This paper reports two cases of young acrobatic gymnasts who presented with long-term, progressive lumbosciatic pain and lower limb dysesthesia. One gymnast presented with additional neurogenic bladder dysfunction. Diagnostic testing revealed L5-S1 spondylolisthesis due to bilateral isthmic lysis in both gymnasts. Both underwent L4-S2 fixation followed by L5-S1 transdiscal arthrodesis with Rialto sacroiliac fusion system (Medtronic®, Minneapolis, MN, USA). Favorable evolution of neuromotor symptoms was observed after rehabilitation, with less residual neurological impairment in the case of higher-grade spondylolisthesis. This case series aims to emphasize the importance of recognizing this pathology in athletes as well as its correct management. Early surgical intervention can prevent the onset and progression of neurological deficits.
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Affiliation(s)
- Andreia Silva
- Physical Medicine and Rehabilitation Department, Tondela-Viseu Hospital Center, Viseu, PRT
| | - Marcel Sincari
- Neurosurgery Department, Tondela-Viseu Hospital Center, Viseu, PRT
| | - Irina Peixoto
- Physical Medicine and Rehabilitation Department, Tondela-Viseu Hospital Center, Viseu, PRT
| | - Mário Vaz
- Physical Medicine and Rehabilitation Department, Tondela-Viseu Hospital Center, Viseu, PRT
| | - Eduardo Mendes
- Orthopaedics and Traumatology Department, Tondela-Viseu Hospital Center, Viseu, PRT
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Fan G, Li Y, Yang S, Qin J, Huang L, Liu H, He S, Liao X. Research topics and hotspot trends of lumbar spondylolisthesis: A text-mining study with machine learning. Front Surg 2023; 9:1037978. [PMID: 36684199 PMCID: PMC9852633 DOI: 10.3389/fsurg.2022.1037978] [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: 09/06/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives The study aimed to conduct a bibliometric analysis of publications concerning lumbar spondylolisthesis, as well as summarize its research topics and hotspot trends with machine-learning based text mining. Methods The data were extracted from the Web of Science Core Collection (WoSCC) database and then analyzed in Rstudio1.3.1 and CiteSpace5.8. Annual publication production and the top-20 productive authors over time were obtained. Additionally, top-20 productive journals and top-20 influential journals were compared by spine-subspecialty or not. Similarly, top-20 productive countries/regions and top-20 influential countries/regions were compared by they were developed countries/regions or not. The collaborative relationship among countries and institutions were presented. The main topics of lumbar spondylolisthesis were classified by Latent Dirichlet allocation (LDA) analysis, and the hotspot trends were indicated by keywords with strongest citation bursts. Results Up to 2021, a total number of 4,245 articles concerning lumbar spondylolisthesis were finally included for bibliometric analysis. Spine-subspecialty journals were found to be dominant in the productivity and the impact of the field, and SPINE, EUROPEAN SPINE JOURNAL and JOURNAL OF NEUROSURGERY-SPINE were the top-3 productive and the top-3 influential journals in this field. USA, Japan and China have contributed to over half of the publication productivity, but European countries seemed to publish more influential articles. It seemed that developed countries/regions tended to produce more articles and more influential articles, and international collaborations mainly occurred among USA, Europe and eastern Asia. Publications concerning surgical management was the major topic, followed by radiographic assessment and epidemiology for this field. Surgical management especially minimally invasive technique for lumbar spondylolisthesis were the recent hotspots over the past 5 years. Conclusions The study successfully summarized the productivity and impact of different entities, which should benefit the journal selection and pursuit of international collaboration for researcher who were interested in the field of lumbar spondylolisthesis. Additionally, the current study may encourage more researchers joining in the field and somewhat inform their research direction in the future.
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Affiliation(s)
- Guoxin Fan
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China,Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, China,Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yufeng Li
- Department of Sports Medicine, The Eighth Affiliated Hospital Sun Yat-sen University, Shenzhen, China
| | - Sheng Yang
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China,Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiaqi Qin
- Artificial Intelligence Innovation Center, Research Institute of Tsinghua, Pearl River Delta, Guangzhou, China
| | - Longfei Huang
- Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, China
| | - Huaqing Liu
- Artificial Intelligence Innovation Center, Research Institute of Tsinghua, Pearl River Delta, Guangzhou, China
| | - Shisheng He
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China,Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China,Correspondence: Shisheng He Xiang Liao
| | - Xiang Liao
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China,Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, China,Correspondence: Shisheng He Xiang Liao
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Hollabaugh WL, Foley Davelaar CM, McHorse KJ, Achar SA, MacDonald JP, Riederer MF. Clinical Practice Patterns of Isthmic Spondylolysis in Young Athletes: A Survey of Pediatric Research in Sports Medicine Members. Curr Sports Med Rep 2022; 21:405-412. [PMID: 36342395 DOI: 10.1249/jsr.0000000000001008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ABSTRACT Isthmic spondylolysis is a common cause of back pain in young athletes. The condition presents to numerous medical providers who employ a variety of different practices in diagnosis and management. The purpose of this study was twofold: to review the literature of diagnosis and management of the young athlete with isthmic spondylolysis and to survey Pediatric Research in Sports Medicine (PRiSM) members during the 2021 PRiSM Annual Meeting on practice patterns of diagnosis and management of the young athlete with isthmic spondylolysis. The response rate was 27%. Per respondents: 24% obtain oblique radiographs; 90% use magnetic resonance imaging as the advanced imaging modality; 60% treat with bracing; 57% recommend rest prior to physical therapy (PT); 53% prescribe return to sport activity restrictions. Although there are similarities in the diagnosis of isthmic spondylolysis in young athletes, this survey confirmed variability in management, especially bracing, timing of PT and return to sport activity restrictions.
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Affiliation(s)
- William L Hollabaugh
- Department of Orthopaedic Surgery, Division of Sports Medicine, Vanderbilt University Medical Center, TN
| | - Cassidy M Foley Davelaar
- Nemours Children's Health, Department of Orthopedics and Sports Medicine, University of Central Florida College of Medicine, FL
| | | | - Suraj A Achar
- Department of Family Medicine, Division of Sports Medicine, University of California San Diego Health, CA
| | - James P MacDonald
- Department of Pediatrics, Division of Sports Medicine, Nationwide Children's Hospital, OH
| | - Mark F Riederer
- Department of Orthopaedic Surgery, Divisions of Pediatric Orthopaedics and Sports Medicine, University of Michigan, MI
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9
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Choi JH, Ochoa JK, Lubinus A, Timon S, Lee YP, Bhatia NN. Management of lumbar spondylolysis in the adolescent athlete: a review of over 200 cases. Spine J 2022; 22:1628-1633. [PMID: 35504566 DOI: 10.1016/j.spinee.2022.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/09/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Spondylolysis is a defect of the pars interarticularis of vertebrae, most commonly seen at L5 and L4. The etiology of spondylolysis and isthmic spondylolisthesis is generally considered to be a result of repetitive mechanical stress to the weak portion of the vertebrae. A higher incidence of spondylolysis is observed in young athletes. Symptomatic spondylolysis can be successfully treated conservatively, but there is currently a limited consensus on treatment modalities and a lack of large-scale clinical trials. PURPOSE The purpose of the present study was to investigate the optimal treatment algorithm for symptomatic spondylolysis in adolescent athletes and evaluate the functional outcomes of those undergoing the nonoperative treatment. STUDY DESIGN A retrospective review. PATIENT SAMPLE Two hundred one adolescent patients ranging from age 10 to 19 involved in athletics OUTCOME MEASURES: Injury characteristics (age, mechanism, time), sports played, bone stimulator use, bony healing at 3 months on computed tomography (CT) scans, return to sports, corticosteroid injection use. METHODS Two hundred one adolescent athlete patients (62 females and 139 males) diagnosed with spondylolysis between 2007 and 2019 were retrospectively reviewed. Diagnosis was based on plain radiography followed by magnetic resonance imaging. All patients were treated conservatively with cessation of sports activity, thoracolumbosacral orthosis, and external bone stimulator for three months after diagnosis. CT scans were obtained for the 3-month follow-up visits to assess bony healing. Subsequently the patients received 6 weeks of rehabilitation focused on core strengthening. Symptomatic patients after the treatment were referred for steroid injections and continued with the rehabilitation protocol. RESULTS The most common age of injury was 15 years old, following a strong normal distribution. The most commonly played sport was football, followed by baseball/softball. The primary mechanism of injury was weight training closely followed by a football injury. The first quarter of the calendar year had the highest incidence of injuries with the most injuries occurring in March and the least occurring in December. One hundred fifty-two athletes reported using bone stimulators as prescribed, and these patients showed a significantly higher rate of bony healing on follow-up CT scans than those who did not use bone stimulators. One hundred ninety-seven patients (98%) returned to sports or similar level of activities. Thirty-seven patients (18%) received facet or epidural steroid injections due to continued pain and one patient underwent a surgical procedure. Follow-up CT scans showed 49.8% bony healing. CONCLUSIONS Conservative treatment of spondylolysis in adolescent athletes with cessation of sports, thoracolumbosacral orthosis, and bone stimulator followed by rehabilitation was associated with excellent outcomes in terms of return to sports.
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Affiliation(s)
- Jeffrey H Choi
- Department of Orthopaedic Surgery, University of California, 101 The City Dr S, Pavilion 3. Building 29A, Orange, CA 92868, USA.
| | - Jonathan K Ochoa
- Department of Orthopaedic Surgery, University of California, 101 The City Dr S, Pavilion 3. Building 29A, Orange, CA 92868, USA
| | - Ariadna Lubinus
- All Star Orthopaedics and Sports Medicine, 910 E Southlake Blvd #155, Southlake, TX 76092, Southlake, TX, USA
| | - Stephen Timon
- All Star Orthopaedics and Sports Medicine, 910 E Southlake Blvd #155, Southlake, TX 76092, Southlake, TX, USA
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California, 101 The City Dr S, Pavilion 3. Building 29A, Orange, CA 92868, USA
| | - Nitin N Bhatia
- Department of Orthopaedic Surgery, University of California, 101 The City Dr S, Pavilion 3. Building 29A, Orange, CA 92868, USA
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Wall J, Meehan WP, Trompeter K, Gissane C, Mockler D, van Dyk N, Wilson F. Incidence, prevalence and risk factors for low back pain in adolescent athletes: a systematic review and meta-analysis. Br J Sports Med 2022; 56:1299-1306. [PMID: 36150752 DOI: 10.1136/bjsports-2021-104749] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the incidence, prevalence, risk factors and morphological presentations of low back pain (LBP) in adolescent athletes. DESIGN Systematic review with meta-analysis. DATA SOURCES Medline, Embase, CINAHL via EBSCO, Web of Science, Scopus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies evaluating the incidence and/or prevalence of LBP in adolescent athletes across all sports. RESULTS There were 80 studies included. The pooled incidence estimate of LBP in adolescent athletes was 11% (95% CI 8% to 13%, I2=0%) for 2 years, 36.0% (95% CI 4% to 68%, I2=99.3%) for 12 months and 14% (95% CI 7% to 22%, I2=76%) for 6 months incidence estimates. The pooled prevalence estimate of LBP in adolescent athletes was 42% (95% CI 29% to 55%, I2=96.6%) for last 12 months, 46% (95% CI 41.0% to 52%, I2=56%) for last 3 months and 16% (95% CI 9% to 23%, I2=98.3%) for point prevalence. Potential risk factors were sport participation, sport volume/intensity, concurrent lower extremity pain, overweight/high body mass index, older adolescent age, female sex and family history of LBP. The most common morphology reported was spondylolysis. Methodological quality was deemed high in 73% of cross-sectional studies and in 30% of cohort studies. Common reasons for downgrading at quality assessment were use of non-validated survey instruments and imprecision or absence of LBP definition. SUMMARY/CONCLUSION LBP is common among adolescent athletes, although incidence and prevalence vary considerably due to differences in study methodology, definitions of LBP and data collection. PROSPERO REGISTRATION NUMBER CRD42020157206.
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Affiliation(s)
- Julia Wall
- Discipline of Physiotherapy, School of Medicine, Trinity College, Dublin, Ireland
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Boston Children's Hospital, Waltham, Massachusetts, USA
| | - Katharina Trompeter
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit Bochum, Bochum, Nordrhein-Westfalen, Germany.,Department of Sports Medicine and Sports Nutrition, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Conor Gissane
- Discipline of Physiotherapy, School of Medicine, Trinity College, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity College Dublin, Dublin, Ireland
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Fiona Wilson
- Discipline of Physiotherapy, School of Medicine, Trinity College, Dublin, Ireland
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11
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Hung ND, Duc NM, Hang NT, Anh NTH, Minh ND, Hue ND. The efficacy of quantitative magnetic resonance imaging in the diagnosis of unstable L4/L5 degenerative spondylolisthesis. Biomed Rep 2022; 17:67. [PMID: 35815186 PMCID: PMC9260153 DOI: 10.3892/br.2022.1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/19/2022] [Indexed: 11/06/2022] Open
Abstract
Lumbar degenerative spondylolisthesis (LDS) is a common degenerative disease that particularly affects the elderly. LDS can occur in any segment of the spine but is most commonly found in the L4/L5 segment. In the present study, a quantitative study of lumbar MRI measurements was conducted to identify predisposing factors indicative of spinal instability in patients with L4/L5 LDS. In total, 81 patients [58 patients in the stable group (SG) and 23 patients in the unstable group (UG)] who were diagnosed with L4/L5 LDS on X-ray and MRI between January 2021 and January 2022 were included in this study. Disk height, disk signal intensity on T1-weighted (T1W) and T2-weighted (T2W) images, facet joint fluid thickness, and ligamentum flavum thickness were measured on MRI, and the differences in these parameters between the two groups were evaluated. The receiver operating characteristic curve was generated, and the area under the curve (AUC), cut-off value, sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) were calculated for parameters found to be significantly different between the two groups. The facet joint fluid was significantly thicker in the UG than in the SG (P<0.01), and a cut-off value of 1.45 mm was found to have an AUC of 0.77 and an SE, SP, PPV, and NPV of 73.9, 67.2, 69.3, and 69.77%, respectively. No significant differences were identified between the two groups for mean disk height, ligamentum flavum thickness, or disk signal intensity on T1W or T2W images. The facet joint fluid thickness on axial T2W images may represent a useful predictor of spinal instability in patients with LDS. Therefore, spinal instability should be assessed, and additional evaluation methods, such as standing lateral flexion-extension radiographs, should be performed when facet fluid is detected on lumbar MRI.
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Affiliation(s)
- Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam.,Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam
| | - Nguyen-Thi Hang
- Department of Radiology, Hai Phong International Hospital, Hai Phong 180000, Vietnam
| | - Nguyen-Thi Hai Anh
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Nguyen Dinh Minh
- Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
| | - Nguyen Duy Hue
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam.,Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
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Ali AA, Jacobs BM, Gandhi A, Brooks M. Baastrup’s Disease in Pediatric Gymnasts. CHILDREN 2022; 9:children9071018. [PMID: 35884004 PMCID: PMC9323245 DOI: 10.3390/children9071018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022]
Abstract
Baastrup’s disease is a rare, often misdiagnosed, and causes back pain in children. It is characterized by degenerative changes of both spinous processes and interspinous soft tissues between two adjacent vertebrae. Repetitive spinal movements in the sagittal plane predispose injury to posterior elements of the spine. Chronic flexion and extension strain the interspinous ligament, causing the neighboring spinous processes to adjoin. Patients typically report midline back pain in the lumbar region, which radiates both cephalad and caudad but not laterally. Pain is aggravated by extension and palpation and is alleviated with flexion. Some children with Baastrup’s do not experience pain but present with swelling along the spinous processes. Diagnosis is dependent on distinctive radiologic findings and exam features. Increased interspinous spaces and bone remodeling may be observed. While the current treatment for pain associated with Baastrup’s is directed towards physical therapy, massage therapy, nonsteroidal anti-inflammatory medications, muscle relaxants, and rest from activity, this is the first report of children undergoing interventional modalities for the treatment of back pain associated with Baastrup’s disease. We present two unique pediatric cases of female gymnasts with Baastrup’s disease who were successfully treated by two different techniques: interspinous ligament injection and medial branch block.
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Affiliation(s)
- Arsalan Akbar Ali
- Texas Christian University School of Medicine, Department of Neuroscience, Cook Children’s Healthcare System 801 Seventh Avenue, Fort Worth, TX 76104, USA; (A.A.A.); (B.M.J.)
| | - Benjamin Matthew Jacobs
- Texas Christian University School of Medicine, Department of Neuroscience, Cook Children’s Healthcare System 801 Seventh Avenue, Fort Worth, TX 76104, USA; (A.A.A.); (B.M.J.)
| | - Artee Gandhi
- Cook Children’s Medical Center, Fort Worth, TX 76104, USA;
| | - Meredith Brooks
- Cook Children’s Medical Center, Fort Worth, TX 76104, USA;
- Department of Anesthesia and Pain Management, Cook Children’s Dodson Specialty Clinics 1500 Cooper Street, Fort Worth, TX 76104, USA
- Correspondence: ; Tel.: +1-682-885-3621
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Keylock L, Alway P, Felton P, McCaig S, Brooke-Wavell K, King M, Peirce N. Lumbar bone stress injuries and risk factors in adolescent cricket fast bowlers. J Sports Sci 2022; 40:1336-1342. [DOI: 10.1080/02640414.2022.2080161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Laura Keylock
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Peter Alway
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Cricket Performance Centre, England and Wales Cricket Board, Loughborough, UK
| | - Paul Felton
- Department of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Steve McCaig
- Athlete Health, English Institute of Sport, Manchester, UK
| | | | - Mark King
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Nicholas Peirce
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Cricket Performance Centre, England and Wales Cricket Board, Loughborough, UK
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Clinical results of restoration of pars interarticularis defect in adults with percutaneous intralaminar screw fixation. World Neurosurg 2022; 164:e290-e299. [PMID: 35552035 DOI: 10.1016/j.wneu.2022.04.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aims to report the clinical outcomes associated with the percutaneous intralaminar screw repair performed for pars defects in adults. METHODS Adult patients who got their lumbar L5 spondylolysis repaired via the modified Buck's procedure between 2017 and 2020 were retrospectively evaluated. The preoperative and postoperative clinical outcomes at 1, 3, 6, and 12 months were evaluated for patients with and without fusion using the visual analog scale (VAS), Oswetry Disability Index (ODI), and the Short Form Health Survey 36 (SF-36). At 12 months, the fusion status of all the patients was assessed using bilateral direct X-rays. RESULTS Thirty patients with spondylolysis were identified (11 men and 19 women). All patients had bilateral L5 pars defects, and at 12 months, the fusion rate was 60% (18/30). There was no difference between the fusion and nonfusion groups in terms of their VAS, ODI, SF-36-physical component summary (PCS), and SF-36-mental component summary (MCS) scores (p > 0.05). Within-group comparisons of the two groups revealed significant changes at follow-up (p < 0.05). CONCLUSIONS Minimally invasive repair of lumbar spondylolysis with percutaneous intralaminar screw fixation restores the motion segment and can provide early resumption of physical activity with minimal muscle damage, smaller skin incision, and less soft tissue dissection.
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15
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Meng H, Gao Y, Lu P, Zhao GM, Zhang ZC, Sun TS, Li F. Risk factor analysis of disc and facet joint degeneration after intersegmental pedicle screw fixation for lumbar spondylolysis. J Orthop Surg Res 2022; 17:247. [PMID: 35459170 PMCID: PMC9034521 DOI: 10.1186/s13018-022-03082-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/17/2022] [Indexed: 01/17/2023] Open
Abstract
Background Patients who do not respond to conservative treatment of the isthmus are often treated with surgery. We used direct repair plus intersegment pedicle screw fixation for the treatment of lumbar spondylolysis. The aim of this observational study was to assess the effects of this technique and evaluate various risk factors potentially predicting the probability of disc and facet joint degeneration after instrumentation. Methods The study included 54 male L5 spondylolysis patients who underwent pars repair and intersegment fixation using pedicle screws. Bony union was evaluated using reconstruction images of computed tomography. Radiographic changes, including disc height, vertebral slip, facet joint and disc degeneration in the grade of adjacent and fixed segments, were determined from before to final follow-up. Logistic regression analysis was performed to identify factors associated with the incidence of disc and facet joint degeneration. Results Bony union was achieved in all cases. Logistic regression analysis revealed that instrumentation durations of greater than 15.5 months and 21.0 months were significant risk factors for the incidence of L4/5 and L5S1 facet degeneration, respectively. Conclusions Intersegmental pedicle screw fixation provides good surgical outcomes and good isthmic bony union rates in patients with lumbar spondylolysis. The duration of fixation was confirmed as a risk factor for facet joint degeneration. Once bony union is achieved, instrument removal should be recommended.
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Affiliation(s)
- Hao Meng
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China.
| | - Yuan Gao
- Department of Gynecology and Obstetrics, The 1st Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peng Lu
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China
| | - Guang-Min Zhao
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China
| | - Zhi-Cheng Zhang
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China
| | - Tian-Sheng Sun
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China
| | - Fang Li
- Department of Orthopaedics, The 7th Medical Center of Chinese PLA General Hospital, No. 5 Nanmen Cang, Beijing, 100700, China.
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16
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Suggested Applications of Musculoskeletal Ultrasound to Identify the Etiologies of Low Back Pain. Asian J Sports Med 2022. [DOI: 10.5812/asjsm.117727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Ibiebele A, Scott D, D'Hemecourt P, Meehan WP. The use of bracing in the management of lumbar spondylolysis. PM R 2022; 14:604-610. [PMID: 35014189 DOI: 10.1002/pmrj.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Abiye Ibiebele
- Medical Sports Medicine Fellow, Boston Children's Hospital, 9 Hope Avenue, Suite 100, Waltham, Massachusetts, United States
| | - Daphne Scott
- Primary Sports Medicine, HSS
- Hospital for Special Surgery, 535 East 70th Street, New York, New York, United States
| | | | - William P Meehan
- Micheli Center for Sports Injury Prevention, Clinical Effectiveness Research Center, Department of Orthopedics , Boston Children's Hospital, 9 Hope Avenue, Suite 100 Waltha m, Massachusetts 02453, United States, HSS
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Debnath UK. Lumbar spondylolysis - Current concepts review. J Clin Orthop Trauma 2021; 21:101535. [PMID: 34405089 PMCID: PMC8358467 DOI: 10.1016/j.jcot.2021.101535] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/27/2021] [Accepted: 07/26/2021] [Indexed: 12/27/2022] Open
Abstract
Lumbar pars interarticularis (PI) injury or spondylolysis occurs only in humans. This represents a stress fracture of the PI. Excessive loading in repetitive hyperextension is a significant risk factor and occurs most commonly at L5 followed by L4. It is bilateral in 80% of symptomatic cases but can be unilateral defect as well which runs a more benign course. Symptoms of low back pain relating to this lesion are more common in young athletes involved in trunk twisting sports. Like other stress fractures, the pain may come on abruptly or more insidiously over time and only related to certain activities. The pathologic progression starts with a stress reaction in the pars, progressing to an incomplete stress fracture, and then a complete pars fracture. Diagnosis is dependent on clinical examination and radiological imaging studies (plain radiography, computed tomography (CT) scans and magnetic resonance imaging (MRI) scans). Treatment is dependent on symptoms as well as radiographic stage of the lesion. Conservative management is the mainstay of treating early lesions. A comprehensive rehabilitation program incorporates core spinal stabilization exercises. Athletes should not return to sports until pain free. Professional sporting individuals are at increased risk of failure of resolution of symptoms that may require early surgical repair of the PI defect. Modified Buck's technique & pedicle screw-hook constructs for direct repair has a high success rate in patients who have persistent low back pain. Minimally invasive lumbar pars defect repair has given similar successful outcome with added advantage of minimizing muscle injury, preserving the adjacent joint and reduced hospital stay. Functional outcome is evaluated using the Visual Analogue Scale (VAS) for back pain, Oswestry Disability Index (ODI) and 36-Item Short-Form Health Survey (SF-36). Preoperative ODI and SF-36 physical component scores (PCS) are significant predictor of a good functional outcome.
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Affiliation(s)
- Ujjwal K Debnath
- Professor of Orthopaedics, Jagannath Gupta Institute of Medical Sciences, Kolkata
- Consultant Orthopaedic & Spine, Surgeon, Fortis Hospital, Kolkata
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Cui GY, Han XG, Wei Y, Liu YJ, He D, Sun YQ, Liu B, Tian W. Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis. Orthop Surg 2021; 13:1960-1968. [PMID: 34516712 PMCID: PMC8528995 DOI: 10.1111/os.13044] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 03/25/2021] [Accepted: 04/13/2021] [Indexed: 01/02/2023] Open
Abstract
Objective To compare the clinical efficacy between robot‐assisted minimally invasive transforaminal lumbar interbody fusion (robot‐assisted MIS‐TLIF) and traditional open TLIF surgery in the treatment of lumbar spondylolisthesis. Methods According to the inclusion and exclusion criteria, 48 cases with lumbar spondylolisthesis who received surgical treatment from June 2016 to December 2017 in the spinal surgery department of Beijing Jishuitan Hospital were analyzed in this study, including 23 patients who received robot‐assisted MIS‐TLIF and 25 patients who received traditional open TLIF surgery. The two groups were compared in terms of pedicle screw accuracy evaluated by Gertzbein‐Robbins classification on postoperative computed tomography (CT), operation time, blood loss, postoperative drainage, hospitalization, time to independent ambulation, low back pain evaluated by visual analog scale (VAS), lumbar function evaluated by Oswestry Disability Index (ODI), paraspinal muscles atrophy on magnetic resonance imaging (MRI), and complications. Results Postoperative CT showed that the rate of Grade A screws in the robot‐assisted MIS‐TLIF group was significantly more than that in the open surgery group (χ2 = 4.698, P = 0.025). Compared with the open surgery group, the robot‐assisted MIS‐TLIF group had significantly less intraoperative blood loss, less postoperative drainage, shorter hospitalization, shorter time to independent ambulation, and lower VAS at 3 days post‐operation (P < 0.05). However, the duration of surgery was longer. The VAS of the robot‐assisted MIS‐TLIF group decreased from 6.9 ± 1.8 at pre‐operation to 2.1 ± 0.8 at post‐operation, 1.8 ± 0.7 at 6‐month follow‐up and 1.6 ± 0.5 at 2‐year follow‐up. The VAS of the open surgery group decreased from 6.5 ± 1.7 at pre‐operation to 3.7 ± 2.1 at post‐operation, 2.1 ± 0.6 at 6‐month follow‐up and 1.9 ± 0.5 at 2‐year follow‐up. The ODI of the robot‐assisted MIS‐TLIF group decreased from 57.8% ± 8.9% at pre‐operation to 18.6% ± 4.7% at post‐operation, 15.7% ± 3.9% at 6‐month follow‐up and 14.6% ± 3.7% at 2‐year follow‐up. The ODI of the open surgery group decreased from 56.9% ± 8.8% at pre‐operation to 20.8% ± 5.1% at post‐operation, 17.3% ± 4.2% at 6‐month follow‐up and 16.5% ± 3.8% at 2‐year follow‐up. Paraspinal muscle cross‐sectional area in 2‐year follow‐up in patients of the open surgery group decreased significantly compared to patients of robotic‐assisted MIS‐TLIF group (P = 0.016). Conclusion In the treatment of lumbar spondylolisthesis, robot‐assisted MIS‐TLIF may lead to more precise pedicle screw placement, less intraoperative blood loss, less postoperative drainage, less postoperative pain, quicker recovery, and less paraspinal muscle atrophy than traditional open surgery.
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Affiliation(s)
- Guan-Yu Cui
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Xiao-Guang Han
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Yi Wei
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Ya-Jun Liu
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Da He
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Yu-Qing Sun
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Bo Liu
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
| | - Wei Tian
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Fourth Clinical Medical College of Peking University, Beijing, China
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20
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Adolescent gymnast with persistent back pain. J Paediatr Child Health 2021; 57:1542. [PMID: 34477278 DOI: 10.1111/jpc.2_15358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/26/2020] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
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21
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Yurac R, Bravo JT, Silva Á, Marré B. Spondylolysis Repair Using a Minimally Invasive Modified Buck Technique with Neuronavigation and Neuromonitoring in High School and Professional Athletes: Technical Notes, Case Series, and Literature Review. World Neurosurg 2021; 155:54-63. [PMID: 34365047 DOI: 10.1016/j.wneu.2021.07.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spondylolysis is a defect in the pars interarticularis of the vertebra that occurs frequently in high-performance young athletes. Although nonsurgical management is the mainstay of treatment, surgery is an option for patients with persistent symptoms despite multiple cycles of nonsurgical treatment. Performing a minimally invasive technique reduces complications, postsurgery pain, and hospitalization time and leads to a quick recovery. The aim of this study was to report the clinical results of a series of 3 patients treated with a modification of the Buck technique with a minimally invasive approach. METHODS Three high-performance athletes between 17 and 18 years old who were managed nonsurgically for at least 6 months underwent a modified Buck technique repair with a minimally invasive approach using cannulated compression screws, with neuronavigation and neuromonitoring. Patients were followed at least 6 months with computed tomography scans to assess consolidation and fixation status. Following rehabilitation and in the absence of pain, all 3 athletes returned to their respective sports. No complications were reported. RESULTS All patients presented with bilateral spondylolysis, at L3 in 1 case and at L5 in 2 cases. Patients received conservative management for 12-36 months before surgery. After surgery, consolidation was obtained at 4 months in all patients, who returned to their sports activities in <6 months. CONCLUSIONS The proposed technique shows the advantages of performing minimally invasive surgery in young high-performance athletes, ensuring consolidation and early return to sports activity without complications.
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Affiliation(s)
- Ratko Yurac
- Spine Unit, Department of Orthopedic and Traumatology, Clínica Alemana, Santiago, Chile; Department of Orthopedic and Traumatology, School of Medicine, University del Desarrollo, Santiago, Chile.
| | - José T Bravo
- Department of Orthopedic and Traumatology, School of Medicine, University del Desarrollo, Santiago, Chile
| | - Álvaro Silva
- Spine Unit, Department of Orthopedic and Traumatology, Clínica Alemana, Santiago, Chile; Department of Orthopedic and Traumatology, School of Medicine, University del Desarrollo, Santiago, Chile
| | - Bartolomé Marré
- Spine Unit, Department of Orthopedic and Traumatology, Clínica Alemana, Santiago, Chile; Department of Orthopedic and Traumatology, School of Medicine, University del Desarrollo, Santiago, Chile
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22
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The Management of Acute Lumbar Stress Reactions of the Pedicle and Pars in Professional Athletes Playing Collision Sports. Clin Spine Surg 2021; 34:247-259. [PMID: 32991362 DOI: 10.1097/bsd.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/19/2020] [Indexed: 11/26/2022]
Abstract
Acute stress reactions in the lumbar spine most commonly occur in athletes at the pars interarticularis followed by the pedicle. These reactions occur as a result of repetitive microtrauma from supraphysiological loads applied to the lumbar spine. Characteristic motions such as trunk extension and twisting are also thought to play a role and may be sport-specific. Other risk factors include increased lumbar lordosis, hamstring and thoracolumbar fascia tightness, and abdominal weakness. On physical examination, pain is typically reproduced with lumbar hyperextension. Currently, magnetic resonance imaging or nuclear imaging remain the most sensitive imaging modalities for identifying acute lesions. In the elite athlete, management of these conditions can be challenging, particularly in those playing collision sports such as American football, hockey, or rugby. Nonoperative treatment is the treatment of choice with rehabilitation programs focused on pain-free positioning and progressive strengthening. Operative treatment is rare, but may be warranted for patients symptomatic for >12 months. Specialized diagnosis protocols as well as treatment and return to play guidelines from 4 physicians treating elite athletes playing collision sports are presented and reviewed.
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Borni M, Belmabrouk H, Kammoun B, Boudawara MZ. Evaluation of functional outcomes of lumbar and lumbosacral isthmic and degenerative spondylolisthesis treated surgically. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Aging athletes face unique, increased adversities related to increased mobility and age-related spine issues, such as spinal stenosis, osteoporosis complicated by fragility fractures, and degenerative disk disease. This article covers various spine pathologies that aging athletes experience and ideal treatment of this population to allow safe return to activity.
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Affiliation(s)
- Pramod N Kamalapathy
- Department of Orthopaedics, University of Virginia, 400 Ray Hunt C. Drive, Charlottesville, VA 22903, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedics, University of Virginia, 400 Ray Hunt C. Drive, Charlottesville, VA 22903, USA.
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Abstract
AbstractSpine trauma is a common indication for diagnostic imaging, and there has been a gradual shift to using cross-sectional imaging techniques for screening and evaluating the injured spine, particularly in elderly patients where radiography can be challenging. The classification of spinal injuries has evolved in the past decades to rely on a combination of fracture morphology as defined by diagnostic imaging in conjunction with the clinical presentation to stratify patients to determine optimal management. Radiologists need to be familiar with these classification systems, which rely heavily on imaging findings using CT and MRI, to accurately describe spinal injury.
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Anand Prakash A. Return to play after spondylolysis: An overview. Med J Armed Forces India 2021; 77:6-14. [PMID: 33487859 DOI: 10.1016/j.mjafi.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022] Open
Abstract
Spondylolysis is increasingly associated with specific sports, timely and effective management of which underpins successful return to sports. Hence, the main purpose of this systematic review of reviews [RoR] is to summarize data from published reviews exploring the return to play in athletes with spondylolysis managed conservatively or surgically, thereby providing for recommendations for future practice and research. A systematic review of review of articles published in English and since 2015 was conducted online using PubMed and Google Scholar, as per Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines. Predefined eligibility criteria were applied, and the data thus compiled were analyzed. Study quality was assessed using the AMSTAR-2 checklist. A total of 7 systematic reviews and meta-analysis consisting of 51 primary studies were included in the review. The result of this RoR highlights the knowledge gap and limitations in RTP research post spondylolysis with existing heterogeneity in methods and reporting amid other factors within primary studies. Further quality of the study was found to be of low to critically low confidence based on the AMSTAR-2 scale, suggesting that the results should be interpreted with great caution. Though both conservative and surgical approaches increase the percentage of athletes returning to play, the evidence remains largely limited and inconclusive as to which is better. However, it appears that surgical interventions give those who failed a trial of conservative approach, a better shot at return to play. There is a need for further high-quality, appropriately powered, well-designed, multicentered studies, and also for consensus regarding "returning to play" definition and outcome measures.
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Affiliation(s)
- Akilesh Anand Prakash
- Primary Care Physician, ACS Medical College and Hospital, R.S. Puram, Coimbatore, India
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27
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Nakayama Y, Yamashita K, Sugiura K, Takeuchi M, Morimoto M, Tezuka F, Takata Y, Sakai T, Maeda T, Sairyo K. Surgical management of stress fracture of the contralateral pedicle in a baseball player with unilateral lumbar spondylolysis : A case report. THE JOURNAL OF MEDICAL INVESTIGATION 2020; 67:382-385. [PMID: 33148923 DOI: 10.2152/jmi.67.382] [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: 11/14/2022]
Abstract
We describe successful surgical treatment in a case of L5 unilateral spondylolysis with contralateral pedicle stress fracture that was not resolved by conservative treatment in a high-performing college baseball player. The 20-year-old man presented with left low back pain that stopped his sports activities. Over the previous year, he had experienced a couple of episodes of pain that subsided with cessation of sports but reappeared after a return to sports. Computed tomography and magnetic resonance imaging revealed a right terminal stage pars fracture and a left pedicle stress fracture at L5. The pain originated from the left pedicle fracture, with no pain from the right unilateral spondylolysis. Given that conservative treatment for 1 year had not been effective, we decided on surgical treatment. Bilateral pedicle screws and the smiley face rod method were applied, and both fractures subsequently healed. In the 2 years since the surgery, the patient has returned to sports and has the potential to become a professional player. J. Med. Invest. 67 : 382-385, August, 2020.
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Affiliation(s)
- Yusaku Nakayama
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Makoto Takeuchi
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Masatoshi Morimoto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Zack O, Barak Y, Finestone AS, Krakov A, Slodownik D, Alperovitch-Najenson D, Moshe S. Occupational influences on Spondylolysis and Spondylolisthesis in a cohort of 18-year-old male military conscripts. BMC Musculoskelet Disord 2020; 21:720. [PMID: 33153454 PMCID: PMC7643341 DOI: 10.1186/s12891-020-03747-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The reported prevalence of spondylolysis (SL) in the adult population is 6-7%. Data concerning adolescent-onset spondylolisthesis (SLS) and the impact of certain activities on it is scarce. We examined the risk of clinical progression of SL and SLS as a function of primary severity and occupational strain among military recruits. METHODS Based on the Israel defense Force (IDF) central human resources database, we identified 1521 18-year-old males inducted to the IDF with SL/SLS between the late nineteen nineties and early two-thousands. We followed changes in the SL/SLS status during the 3 years of obligatory military service. Disease severity was classified as Cat2: radiological findings of SL without clinical findings; Cat3: painful SL or asymptomatic grade 1 SLS; Cat4: grade 1 SLS with pain; Cat5: Grade 2 SLS. The soldiers were subdivided into the following occupational categories: administrative, combat, maintenance, and driving. The purpose was to compare the progression rates in different medical categories and job assignments. RESULTS There were 162 recruits in Cat2, 961 in Cat3, and 398 recruits in Cat4. The overall progression rate to Cat5 (grade 2 SLS) was 1.02%. Significant progression rates were seen amongst administrative soldiers with a relatively higher risk of progression from Cat4 (painful-grade-1 SLS: 2.2%) vs. Cat3 (asymptomatic SLS: 0.5%, relative risk = 4.7, p < 0.02). Other occupational categories did not exhibit significant progression rates. CONCLUSION Progression of SL/SLS was highest in Cat4, i.e. for recruits already diagnosed with painful SLS (i.e. with a more severe baseline disorder). Progression did not correlate with military occupation. We recommend further follow-up studies that include, aside from progression rates, incidence rates of newly diagnosed grade 2 SL during military service.
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Affiliation(s)
- Oren Zack
- The Israel Defense Forces, Medical Corps, Tel-Aviv, Israel
- Department of Occupational and Environmental Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv university, Tel-Aviv, Israel
| | - Yair Barak
- The Israel Defense Forces, Medical Corps, Tel-Aviv, Israel
| | - Aharon S. Finestone
- Department of Orthopedics, Shamir Medical Center, Zerifin, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ayala Krakov
- Department of Occupational and Environmental Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv university, Tel-Aviv, Israel
- Department of Occupational Medicine, Hashfela and Jerusalem district, Maccabi Healthcare Services, 15 Rothschild St., Rishon Letzion, Israel
| | - Dani Slodownik
- Department of Occupational and Environmental Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv university, Tel-Aviv, Israel
- Department of Dermatology, Tel Aviv Sourascky Medical Center, Tel Aviv, Israel
| | - Deborah Alperovitch-Najenson
- Department of Occupational and Environmental Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv university, Tel-Aviv, Israel
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shlomo Moshe
- Department of Occupational and Environmental Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv university, Tel-Aviv, Israel
- Department of Occupational Medicine, Hashfela and Jerusalem district, Maccabi Healthcare Services, 15 Rothschild St., Rishon Letzion, Israel
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Straight Leg Raise Test: Influence of Lumbosant© and Assistant Examiner in Hip, Pelvis Tilt and Lumbar Lordosis. Symmetry (Basel) 2020. [DOI: 10.3390/sym12060927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The passive straight leg raise (PSLR) test is widely used to assess hamstring extensibility. However, to accurately measure hamstring extensibility throughout PSLR, appropriate stabilization of the pelvis must be provided in order to minimize the possible influence of any compensatory movement in the scores reached. The main purpose of this study was to demonstrate the degree of influence of the Lumbosant© and an assistant examiner in hamstring extensibility in healthy young adults. A secondary objective was to verify the variability of the posterior pelvic tilt movement. Hamstring muscle extensibility was measured using the traditional (only an examiner) and new (using a low-back protection support Lumbosant© and two trained [principal and assistant] examiners) PSLR procedures. Correlation coefficients were expressed using r values, accompanying descriptors and 90% confidence intervals. Variance explained was expressed via the R2 statistic. To examine possible differences, the Mann-Whitney U-test was conducted. Additionally, Cohen’s d was calculated for all results, and the magnitudes of the effect were interpreted and statistical significance set at p < 0.05. A stepwise multiple regression analysis was performed to examine the relationship between scores and values. The final score that was determined with the new PSLR is significantly lower (13° approximately) than the one obtained through the traditional procedure (75.3 ± 14.4° vs. 89.2 ± 20.8°; d = −0.777 [moderate]). The data presented in this study suggest that the PSLR may overestimate hamstring extensibility unless lumbopelvic movement is controlled. Therefore, we recommend the use of Lumbosant© and an auxiliary examiner to obtain more accurate hamstring extensibility scores.
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Abstract
STUDY DESIGN Literature review. OBJECTIVE To conduct a literature review of studies reporting the incidence of pars interarticularis defects in athletes of specific sports, in order to allow more targeted prevention and treatment strategies to be implemented for the groups at highest risk. METHODS Electronic searches were performed using PubMed, Ovid Medline, EMBASE, Google Scholar, Cochrane Database of Systematic Reviews, and Cochrane Database of Controlled Trials from their dates of inception to September 2017, with the following keywords: "spondylolysis," "sports," "low back pain," and "pars defects." RESULTS A total of 509 total articles were retrieved, of which 114 were used in the final review. The incidence of pars interarticularis defects was found to be highest in diving (35.38%), cricket (31.97%), baseball/softball (26.91%), rugby (22.22%), weightlifting (19.49%), sailing (17.18%), table tennis (15.63%), and wrestling (14.74%). Only 5 studies reported the management instituted for their participants, and these were all case reports. Of 74 players with spondylolysis in these studies, 70 (94.59%) underwent conservative treatment and 4 (5.41%) underwent surgical treatment. 61 (82.43%) returned to their previous level of play, 6 (8.11%) retired, and the disposition of the final 7 was not reported. CONCLUSION The current medical literature provides good evidence that the incidence of pars interarticularis defects is higher in the athletic population, with the highest incidence in diving. There remains no gold standard protocol for the management of pars interarticularis defects. Further research is required to compare conservative therapy to surgical therapy and to compare the various surgical techniques to each other.
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Affiliation(s)
- Samuel Tawfik
- University of New South Wales, Sydney, New South Wales, Australia,St George Hospital, Sydney, New South Wales, Australia,Samuel Tawfik, St George Hospital, Sydney, New South Wales, Australia 2217.
| | - Kevin Phan
- University of New South Wales, Sydney, New South Wales, Australia,Neurospine Surgery Research Group, Sydney, New South Wales, Australia
| | - Ralph J. Mobbs
- Neurospine Surgery Research Group, Sydney, New South Wales, Australia,Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Prashanth J. Rao
- Neurospine Surgery Research Group, Sydney, New South Wales, Australia,University of Sydney, Sydney, New South Wales, Australia,Westmead Hospital, Sydney, New South Wales, Australia
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Abstract
With increasing pediatric participation in organized sport and the early specialization of children in single sports, the number of injuries seen in the pediatric and adolescent athletic population continues to increase. Children experience acute traumatic injuries during practice and competition as well as chronic overuse injuries secondary to the repetitive stress on their developing bodies. The unique nature of the pediatric patient often requires a different diagnostic, prognostic, and treatment approach to sports injuries compared with their adult counterparts.
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Yun H, Hwang JY, Yoo JH. Multidetector CT Findings of Acquired Spondylolysis and Spondylolisthesis after Posterior Lumbar Laminectomy. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:644-653. [PMID: 36238636 PMCID: PMC9431925 DOI: 10.3348/jksr.2020.81.3.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/11/2019] [Accepted: 09/03/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Hyein Yun
- Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Ji Young Hwang
- Department of Radiology, Ewha Womans University Seoul Hospital, Seoul, Korea
- Department of Radiology, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Jeong Hyun Yoo
- Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
- Department of Radiology, Ewha Womans University, College of Medicine, Seoul, Korea
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Ishitani H. Does facet joint morphology affect the development of spondylolysis? J Phys Ther Sci 2020; 32:800-803. [PMID: 33362349 PMCID: PMC7758603 DOI: 10.1589/jpts.32.800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to clarify the contribution of the morphology of the facet
joint in spondylolysis. [Participants and Methods] A total of 68 junior athletes with
lower back pain were evaluated. They were classified into groups B (bilateral
spondylolysis), U (unilateral spondylolysis), and C (without spondylolysis). The same
observer measured the sagittal orientation of the L4/L5 and L5/S1 facet joint angles from
the axial sections, using computed tomography. Facet joint angles were statistically
compared for differences among groups B, UL (the spondylolysis side in group U), UN (the
normal side in group U), and C. [Results] The L4/L5 facet joint angles were significantly
more coronally oriented in groups B and UL than in group C, while the L5/S1 facet joint
angles showed no significant differences among the four groups. [Conclusion] The results
of this study suggest that a more coronal orientation of the L4/L5 facet joint may
increase the point loading through the L5 pars interarticularis in extension and rotation.
Therefore, if the L4/L5 facet joint is more coronally orientated, the patient may be at
the risk of spondylolysis. This observation may aid in predicting patients with increased
possibility of developing spondylolysis.
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Affiliation(s)
- Hayato Ishitani
- Department of Rehabilitation, Funabashi Orthopaedic Hospital Nishifuna Clinic: 2-351 Katsushika-cyo Funabashi-shi, Chiba 273-0032, Japan
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Abstract
Artistic gymnastics is a physically demanding sport that requires flexibility, agility, and extreme upper and lower body strength. The specific biomechanics of the sport leads to a unique injury profile. Gymnastic skills require intense upper body weight-bearing, placing unusual forces across the upper extremity joints and predisposing them to injury. In addition, the required body control during air aerobatics (tumbling, twisting, flipping) necessitates precise landing techniques to avoid spine and lower extremity injury. Common gymnastic injuries include those of the spine and upper extremity such as spondylolysis, shoulder instability, ulnar collateral ligament injuries, capitellar osteochondritis dissecans, and several wrist pathologies. Understanding the injury etiology, prevention, and treatment protocols is important for a successful recovery and return to sport.
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Clinical and imaging characteristics of patients with extreme low back pain or sciatica referred for spinal injection. Neuroradiology 2019; 61:881-889. [PMID: 31101947 DOI: 10.1007/s00234-019-02222-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/06/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE To analyze the causes of pain, imaging characteristics, and therapeutic effect of spinal injection in patients with extreme low back pain or sciatica. METHODS We analyzed 381 consecutive patients with extreme low back pain or sciatica visiting our spinal intervention center between January and December 2017. Clinical and imaging characteristics were analyzed. The treatment response, defined as a numerical pain rating scale decrease of ≥ 30%, was measured. Fisher's exact test was performed to identify the association between the injection response and subsequent lumbar surgery rate. RESULTS The most frequent cause of pain was spinal stenosis, followed by herniated intervertebral disc, facet osteoarthritis, and osteoporotic compression fracture. A herniated intervertebral disc was the most common disorder in patients < 50 years of age, while spinal stenosis was the most common in patients ≥ 50 years of age. Women comprised 66.4% of the study population. The majority of lumbar pathologies occurred below L3/4. Spinal injection was found to be effective in 44.2% of cases. Those who responded to the injection showed a significantly lower rate of lumbar surgery within 6 months (P = 0.004). CONCLUSIONS Those with extreme low back pain or sciatica had clinical and imaging characteristics similar to those with typical low back pain referred for spinal injection. Spinal injection could be an effective method of pain control for patients with extreme low back pain or sciatica.
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Abstract
PURPOSE OF REVIEW Provide a comprehensive overview of lumbar spondylolysis, a frequent cause of lower back pain in children and adolescents, from evaluation to management. RECENT FINDINGS With the surge of structured sports participation in the pediatric population, spondylolysis is a common ailment that afflicts many young athletes due to rigorous competition that taxes the growing spine with repetitive extension and rotation. SUMMARY Spondylolysis is a fracture through the pars interarticularis. When a child presents with lower back pain, spondylolysis should be at the top of the differential. A thorough history and physical examination are essential. In addition, radiographs of the lumbar spine, anterior posterior and lateral views, MRI and, selectively, computed tomography are useful adjuncts to uncover a pars injury. Timely diagnosis facilitates early treatment which includes rest, optimizing bone health, brace treatment, and physical therapy. If delayed or untreated, spondylolysis may result in nonunion or pars defect. If symptomatic, patients may need surgery to fuse the lumbar facet joints or repair the par interarticularis.
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Yabuno S, Yunoki M, Kanda T, Matsumoto A, Hirashita K, Yoshino K. A Case of Nonconsecutive Multiple-level Lumbar Spondylolysis Successfully Treated with Single-level Repair of the Pars Interarticularis. NMC Case Rep J 2019; 6:29-34. [PMID: 30701153 PMCID: PMC6350032 DOI: 10.2176/nmccrj.cr.2018-0147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/02/2018] [Indexed: 11/20/2022] Open
Abstract
Lumbar spondylolysis is commonly recognized at a single-level of the lumbar spine and frequently affects the L5 pars interarticularis unilaterally or bilaterally. Some reports have described multiple-level spondylolysis, most cases of which occur at consecutive lumbar segments. We herein present a rare case of lumbar spondylolysis involving nonconsecutive multiple-level segments; only eight such cases have been reported previously. A 38-year-old man presented with a 10-month history of chronic severe low back pain. Lumbar flexion–extension radiographs and computed tomography revealed spondylolysis at the level of L3 and L5, whereas no spondylolisthesis was present and the intervertebral disc spaces were maintained at all levels. Because 6 months of conservative management failed and repeated diagnostic blocks confirmed that the fracture of the L3 pars interarticularis was generating pain, repair of the bilateral L3 pars interarticularis with the smiley face rod method was performed. At the last follow-up 1 year after surgery, the patient had resumed normal life as a laborer and reported no back pain.
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Affiliation(s)
- Satoru Yabuno
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Masatoshi Yunoki
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Takahiro Kanda
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Atsushi Matsumoto
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Koji Hirashita
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Kimihiro Yoshino
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
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Cheung KK, Dhawan RT, Wilson LF, Peirce NS, Rajeswaran G. Pars interarticularis injury in elite athletes – The role of imaging in diagnosis and management. Eur J Radiol 2018; 108:28-42. [DOI: 10.1016/j.ejrad.2018.08.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 08/31/2018] [Indexed: 02/01/2023]
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Efficacy and outcome predictors of fluoroscopy-guided facet joint injection for spondylolysis. Skeletal Radiol 2018; 47:1137-1144. [PMID: 29396693 DOI: 10.1007/s00256-018-2897-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/05/2018] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the efficacy of fluoroscopy-guided facet joint injection for symptomatic spondylolysis and to analyze the outcome predictors. MATERIALS AND METHODS This study included 108 patients who underwent fluoroscopy-guided facet joint steroid injection for symptomatic spondylolysis with follow-up medical records from January 2013 to December 2016. Among them, 47 patients underwent concomitant epidural steroid injection. Response to injection was assessed at the initial follow-up. The symptom-free interval was analyzed using the Kaplan-Meier method. Outcome predictors were statistically analyzed using independent t test and Chi-square test. RESULTS The facet joint injection was effective in 52 of 108 (48.1%) patients at initial follow-up. Recurrence was reported in 21 of these 52 (40.4%) patients. For the 52 patients in whom facet joint injection was effective, the median symptom-free interval was 298 days (95% confidence interval, 29-567 days). No significant difference was found in the response between the group with facet joint injection only (n = 61) and the group with facet joint injection and additional ESI (n = 47). Additionally, no significant outcome predictors were detected. CONCLUSIONS Fluoroscopy-guided facet joint injection may potentially be an effective therapy for providing prolonged pain relief and avoiding unnecessary surgery for symptomatic spondylolysis without significant outcome predictors.
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Kemmochi M, Sasaki S, Ichimura S. Association between reduced trunk flexibility in children and lumbar stress fractures. J Orthop 2018; 15:122-127. [PMID: 29657454 DOI: 10.1016/j.jor.2018.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022] Open
Abstract
Background We noticed that most of active sports children with low back pain (LBP) have muscle tightness around the pelvis and reduced trunk flexibility. Abnormalities in short-time inversion recovery (STIR) images on magnetic resonance imaging (MRI) can show stress fracture. Therefore, we investigated the associations among LBP, trunk flexibility, and lumbar stress fractures. Methods A total of 130 patients under the age of 18 years complained of LBP were investigated in STIR MRI images. Among these 130 patients, 65 cases of lumbar stress fracture were diagnosed and 65 cases were not diagnosed as a lumbar stress fracture. We compared between a group suspected of stress fracture (suspected group) and a group of stress fracture(stress fracture group)about their trunk flexibility. These groups were investigated about their initial trunk flexibility about below items; Finger floor distance (FFD), Heel to buttock distance (HBD), straight leg raising (SLR). Results Significant differences were observed between suspected group and stress fracture group about every items; SLR (P < 0.001), FFD (P < 0.01), HBD (P < 0.002). Most cases of stress fracture group had reduced trunk flexibility, and low flexibility in pelvic area muscles was observed in 93.8% (61/65) of cases at the initial examination. Otherwise, that of suspected group was 73.8%(48/65). Conclusions Most patients of lumbar stress fracture had reduced trunk flexibility, and their reduced trunk flexibility might not be caused by LBP. In the early diagnosis of lumbar stress fractures using STIR MRI images, there were indicated that reduced trunk flexibility was one of helpful item for lumbar stress fracture.
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Affiliation(s)
- Masahiko Kemmochi
- Kenmochi Orthopedic Surgery Sports Clinic, KOSSMOS Medical Corporation, 42-1 Higashi-honcho Ota City, Gunma, 373-0026, Japan
| | - Shigeru Sasaki
- Department of Orthopaedic Surgery, Kyorin University, 5-4-1 Mitaka, Shimorenjaku, 181-8612, Tokyo, Japan.,Japan Community Health Care Organization, Yamanashi Hospital, 3 Chome-11-16 Asahi, Kofu, Yamanashi Prefecture, 400-0025, Japan
| | - Shoichi Ichimura
- Department of Orthopaedic Surgery, Kyorin University, 5-4-1 Mitaka, Shimorenjaku, 181-8612, Tokyo, Japan
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Zhang S, Ye C, Lai Q, Yu X, Liu X, Nie T, Zhan H, Dai M, Zhang B. Double-level lumbar spondylolysis and spondylolisthesis: A retrospective study. J Orthop Surg Res 2018; 13:55. [PMID: 29548343 PMCID: PMC5857125 DOI: 10.1186/s13018-018-0723-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023] Open
Abstract
Background Lumbar spondylolysis and isthmic spondylolisthesis are common conditions. However, double-level lumbar spondylolysis and spondylolisthesis are rare. We report 24 cases of it along with a review of literature and a briefly description of the clinical and radiological features and integrated management of patients with this condition. Methods Of 1700 inpatients diagnosed with lumbar spondylolisthesis at our hospital between January 2008 and September 2015, we selected those with a diagnosis of double-level spondylolisthesis who underwent surgery. We analyzed the data regarding age, sex, and heavy physical labour. Japanese Orthopaedic Association (JOA) and Visual Analog Scale (VAS) scores were used to evaluate preoperative and postoperative neurological function and back pain. All patients underwent decompression, reduction, and posterior lumbar interbody fusion (PLIF) with autogenous bone chips from posterior decompression or with a cage. After the operation, we were followed up for more than 2 years to observe the effect of the operation. In the meantime, the height of the intervertebral discs was measured at follow-up, and all data are analyzed in SPSS stastic. Results Double-level spondylolisthesis occurred at the L2/L3 and L3/L4 levels in one patient, L3/4 and L4/L5 levels in 11 patients, and L4/L5 and L5/S1 levels in 12 patients. Nine patients also had spondylolysis. Twenty patients underwent posterior lumbar interbody fusion and internal fixation with autologous bone chip, and 4 of them underwent cage and autogenous bone graft fixation. Postoperatively, the major symptoms (neurological dysfunction and low-back pain) improved significantly. Comparison of JOA and VAS scores indicated effective recovery of neurological function (p < 0.05). Postoperative follow-up demonstrated satisfactory interbody fusion and pars interarticularis healing. Conclusions Double-level lumbar spondylolysis and spondylolisthesis occurred more often in women. Most common site of double lumbar spondylolisthesis was L3–L5. The treatment principle was the same as that for single-level spondylolisthesis, but the reset order is questionable. Both, posterior lumbar interbody fusion (PLIF) with autogenous bone chips from posterior decompression or with cage can relieve discomfort in most patients. In our follow-up, we found that there was a high degree of loss in disk height when autogenous bone was used. Therefore, we suggest the use of a cage.
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Affiliation(s)
- Shengtao Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China.,Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Conglin Ye
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China.,Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Qi Lai
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China.,Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Xiaolong Yu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China
| | - Xuqiang Liu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China
| | - Tao Nie
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China
| | - Haibo Zhan
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China.,Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Min Dai
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China.
| | - Bin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yong Wai Zheng Street, Nanchang, Jiangxi, 330006, China.
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History of orthopaedics in China: a brief review. INTERNATIONAL ORTHOPAEDICS 2018; 42:713-717. [PMID: 29455346 DOI: 10.1007/s00264-018-3829-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Chinese orthopaedic surgeons have made a substantial contribution to the development of orthopaedics worldwide, and traditional Chinese medicine (TCM) in orthopaedics has a very long history in China. We make a brief review of the development of orthopaedics in China, intending to pave the way for further understanding of Chinese orthopaedics for scholars all over the world. RESULTS The description of fractures firstly appeared in 3600 years ago in China, and the theories, experience, and treatment strategies of TCM still play important roles in clinical diagnosis and treatment of orthopaedic disorders in our country. Western orthopaedics was first introduced into China in the early twentieth century. After decades of development, Chinese scholars have made some gratifying achievements in orthopaedics. CONCLUSIONS Orthopaedics is constantly evolving, and we need to strengthen the ability of independent innovation to achieve orthopaedic surgeons' Chinese dream, and better serve our patients.
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Mushtaq R, Porrino J, Guzmán Pérez-Carrillo GJ. Imaging of Spondylolysis: The Evolving Role of Magnetic Resonance Imaging. PM R 2018; 10:675-680. [PMID: 29428876 DOI: 10.1016/j.pmrj.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Raza Mushtaq
- Department of Medical Imaging, University of Arizona, Tucson, AZ.,Department of Radiology, University of Washington, Seattle, WA.,Department of Medical Imaging, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724
| | - Jack Porrino
- Department of Medical Imaging, University of Arizona, Tucson, AZ.,Department of Radiology, University of Washington, Seattle, WA.,Department of Medical Imaging, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724
| | - Gloria J Guzmán Pérez-Carrillo
- Department of Medical Imaging, University of Arizona, Tucson, AZ.,Department of Radiology, University of Washington, Seattle, WA.,Department of Medical Imaging, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724
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Song D, Tang M, Li C, Song D, Wang C, Xuan T. Double-level isthmic spondylolisthesis treated with posterior lumbar interbody fusion with cage. Br J Neurosurg 2018; 34:210-214. [PMID: 29361854 DOI: 10.1080/02688697.2018.1428732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: Double-level isthmic spondylolisthesis in the lumbar spine is rare. The authors report on 21 cases of double-level isthmic spondylolisthesis treated by posterior lumbar interbody fusion (PLIF) with cage.Patients and methods: Between 2005 and 2015, twenty-one patients with double-level isthmic spondylolisthesis who underwent posterior lumbar interbody fusion (PLIF) with cage were reviewed retrospectively. The VAS (Visual Analogue Scale) and JOA (Japanese Orthopedic Association) score were used to evaluate preoperative and postoperative clinical outcomes.Results: The back pain and sciatica decreased from 6.53 and 4.24 points preoperatively to 1.80 and 1.18 points on the VAS at final follow-up, respectively. The average JOA score improved from 13.4 ± 3.2 preoperative to 25.4 ± 1.5 (range, 17-28) points postoperative. The average recovery rate was 76.9%. The good and excellent rate was 85.7% (18/21). The fusion rate was 95.2% (20/21). Changes in disc height, degree of listhesis, whole lumbar lordosis, and sacral inclination following surgery were also observed.Conclusions: Our results suggest that PLIF with cage appears to be an appropriate technique for the treatment of double-level isthmic spondylolisthesis.
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Affiliation(s)
- DeWei Song
- Department of Minimally Invasive Pain Treatment, Mengyin County Hospital, Linyi City, Shandong Province, China
| | - Ming Tang
- Department of Minimally Invasive Pain Treatment, Huantai County Hospital, Zibo City, Shandong Province, China
| | - CanHui Li
- Department of Spine Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, China
| | - DeYong Song
- Department of Spine Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, China
| | - ChangBing Wang
- Department of Spine Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, China
| | - TianHang Xuan
- Department of Spine Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, China
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Voisin MR, Witiw CD, Deorajh R, Guha D, Oremakinde A, Wang S, Yang V. Multilevel Spondylolysis Repair Using the "Smiley Face" Technique with 3-Dimensional Intraoperative Spinal Navigation. World Neurosurg 2017; 109:e609-e614. [PMID: 29054782 DOI: 10.1016/j.wneu.2017.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND/OBJECTIVE Multilevel spondylolysis is a rare cause of progressive lower back pain, and patients who fail conservative management are treated surgically. Direct repair methods can maintain mobility and lead to decreased morbidity compared with spinal fusion in single-level spondylolysis. In this paper, we present a patient with nonadjacent multilevel spondylolysis who underwent the "smiley face" technique of direct multilevel repair without fusion using 3-dimensional intraoperative spinal navigation. METHODS Bilateral spondylolysis at L3 and L5 with associated spondylolisthesis in a 50-year-old male was repaired using the "smiley face" technique. Patient-reported outcomes, including the Oswestry Disability Index (ODI) and visual analog scale scores for back and leg pain, were assessed preoperatively along with 6 weeks and 4 months postoperatively. RESULTS Postoperative computed tomography imaging showed precise screw insertion and rod placement along with stable hardware alignment in follow-up imaging. The patient's ODI and lower back visual analog scale scores decreased from 25 to 8 and 7.5 to 4, respectively, correlating to an excellent outcome on ODI. CONCLUSION Direct repair and avoidance of fusion is possible and can provide good functional outcomes in patients with nonadjacent multilevel spondylolysis and associated spondylolisthesis.
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Affiliation(s)
- Mathew R Voisin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Deorajh
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Daipayan Guha
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Adetunji Oremakinde
- Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Shelly Wang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Victor Yang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
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Abstract
STUDY DESIGN Clinical case report of unilateral pedicular stress fracture with a contralateral spondylolysis in a male high-school athlete presenting with low back pain. OBJECTIVE To report this uncommon cause of low back pain in an adolescent athlete, and review the relevant literature. SUMMARY OF BACKGROUND DATA The incidence of spondylolysis in the Caucasian population was found to be about 3% to 6%. This number is probably higher in the athletic adolescent age group, with reports ranging from 8% to 15%. Spondylolysis may be associated with pedicle fracture, usually on the contralateral side. This is an uncommon phenomenon that is not well described in the adolescent age group. METHODS A 16-year-old male athlete presents with low back pain and limitation in sports as well as in daily activities. Clinical evaluation was suspicious for, and radiographic evaluation revealed left-sided L5 spondylolysis as well as contralateral L5 pedicle fracture. Conservative management included Boston Overlapping brace, external electrical stimulation, modification of activities, and a comprehensive physical therapy program. RESULTS Radiological evaluation revealed persistent left L5 pars defect and advanced healing of the contralateral pedicle fracture. The patient achieved complete pain relief and returned to varsity level sporting activity. CONCLUSION Complete radiographic and clinical healing of the pedicle defect was observed, with return competitive varsity-level football without symptoms. LEVEL OF EVIDENCE 5.
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Song D, Song D, Zhang K, Chen Z, Wang F, Xuan T. Double-level isthmic spondylolisthesis treated with posterior lumbar interbody fusion: A review of 32 cases. Clin Neurol Neurosurg 2017; 161:35-40. [PMID: 28843115 DOI: 10.1016/j.clineuro.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 08/11/2017] [Accepted: 08/15/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The incidence of double-level isthmic spondylolisthesis is rare. The aim of this study is to evaluate the short-term functional and radiological outcomes of surgical treatment for double-level isthmic spondylolisthesis. PATIENTS AND METHODS Between 2004 and 2014, thirty-two patients with double-level isthmic spondylolisthesis who underwent posterior lumbar interbody fusion (PLIF) with autogenous bone chips were reviewed retrospectively. The clinical outcomes were measured by VAS (Visual analog scale) and JOA(Japanese Orthopedic Association) score. RESULTS At an average follow-up of 2.8 years, the mean score on the VAS of back pain and sciatica decreased from 6.48 and 4.26 points preoperatively to 1.82 and 1.10 points at final follow-up, respectively. The average JOA score improved from 13.8±3.1 preoperative to 25.6±1.3 (range, 17-28) points postoperative. The average recovery rate was 77.6%. The good and excellent rate was 84.3% (27/32). The fusion rate was 87.5% (28/32). Changes in disc height, degree of listhesis, whole lumbar lordosis, and sacral inclination between the pre- and postoperative periods were significant. CONCLUSIONS Our findings suggest that PLIF with autogenous bone chips for double-level isthmic spondylolisthesis could yield good functional short-term results. It seems to be a viable approach in the treatment of double-level isthmic spondylolisthesis.
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Affiliation(s)
- DeYong Song
- Department of Spine Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, China
| | - DeWei Song
- Department of Minimally invasive pain treatment, Mengyin County Hospital, Linyi City, Shandong Province, China
| | - KeHui Zhang
- Department of Neurosurgery, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, China
| | - Zhong Chen
- Department of Spine Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou City, Guangdong Province, China.
| | - Feng Wang
- Department of Spine Surgery, Foshan Chancheng Central Hospital, Foshan City, Guangdong Province, China
| | - TianHang Xuan
- Department of Spine Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, China
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Malliaropoulos N, Bikos G, Meke M, Tsifountoudis I, Pyne D, Korakakis V. Mechanical Low Back Pain in Elite Track and Field Athletes: An observational cohort study. J Back Musculoskelet Rehabil 2017; 30:681-689. [PMID: 28655123 DOI: 10.3233/bmr-150390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of the study was to gain information about the incidence of mechanical Low Back Pain (MLBP) injuries etiology in elite track and field athletes and to assess the recurrence rate. BACKGROUND The prevalence and the etiology of Low Back Pain (LBP) in athletic populations at the elite level of competition lack of longitudinal studies focused on certain sport fields. The present study evaluates MLBP incidents in elite track and field athletes visiting National Track and Field Centre in Thessaloniki, Greece and classifies MLBP according to etiology. METHODS One hundred and thirty Elite Track and Field Athletes with MLBP injuries were included in a 20-year observational cohort study recording the initial MLBP etiology according to a classification system based on mechanical diagnosis. It was examined if age, gender and sport category predispose the incidence of the initial MLBP etiology and if they consist risk factors for MLBP recurrence. RESULTS Discogenic MLBP in elite track and field athletes was significantly higher at 46.9% (α= 0.05) compared with the other MLBP etiologies under consideration. Secondary findings of the present study regarding the incidence of MLBP etiology categories did not reveal significant associations with gender, age and contest categories (α= 0.05). Additionally, recurrence pathophysiology showed that discogenic MLBP obtained high recurrence rates at 0.48 (14 athletes from 29 athletes recurred) compared with other etiologies, followed by back elements injury recurrence rate at 0.24 (7 athletes out of 29). CONCLUSIONS The study provided us with evidence of higher incidence of discogenic etiology of MLBP in elite track and field athletes. Further research is suggested in the use of etiology related LBP classification system in order to evaluate causes, prevalence and epidemiology of MLBP in athletic populations of specific sport categories.
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Affiliation(s)
- Nikolaos Malliaropoulos
- Sports and Exercise Medicine Clinic, Thessaloniki, Asklipiou, Greece.,National Track and Field Centre, Sports Medicine Clinic of S.E.G.A.S., Thessaloniki, Greece.,European Sports Care, London, UK.,Sports Clinic, Rheumatology Department, Barts Health NHS Trust, London, UK.,Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK
| | - Georgios Bikos
- National Track and Field Centre, Sports Medicine Clinic of S.E.G.A.S., Thessaloniki, Greece.,Euromedica-Arogi Rehabilitation Clinic, Pylaia, Thessaloniki, Greece
| | - Maria Meke
- Sports and Exercise Medicine Clinic, Thessaloniki, Asklipiou, Greece.,National Track and Field Centre, Sports Medicine Clinic of S.E.G.A.S., Thessaloniki, Greece
| | | | - Dev Pyne
- European Sports Care, London, UK.,Sports Clinic, Rheumatology Department, Barts Health NHS Trust, London, UK.,Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK
| | - Vasileios Korakakis
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Faculty of Physical Education and Sport Science, University of Thessaly, Trikala, Greece.,Hellenic Orthopaedic Manipulative Therapy Diploma, Athens, Greece
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50
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Shin SH, Kim SJ. Bone scintigraphy in patients with pain. Korean J Pain 2017; 30:165-175. [PMID: 28757916 PMCID: PMC5532523 DOI: 10.3344/kjp.2017.30.3.165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 06/26/2017] [Accepted: 06/26/2017] [Indexed: 11/24/2022] Open
Abstract
Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disorder of the extremities, which is characterized by sensory, autonomic, vasomotor, and trophic disturbances. To assist the diagnosis of CRPS, three-phase bone scintigraphy is thought to be superior compared to other modalities, and could be used to rule out CRPS due to its high specificity. Studies regarding the effect of bone scintigraphy in patients with extremity pain have not been widely conducted. Ultrasound, CT and MRI are widely used imaging modalities for evaluating extremity pain. However, SPECT/CT has an additional role in assessing pain in the extremities.
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Affiliation(s)
- Seung Hyeon Shin
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Korea
| | - Seong Jang Kim
- Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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