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Ye Y, Yang H, Ma T, Zhu K, Xu G, Han Z, Zhang Z, Wu N, Guo X, Li H, Zhou P, Bao Z, Zhang C. Buck technique supplemented by temporary intersegmental pedicle screw fixation to repair lumbar spondylolysis in youth. J Orthop Surg Res 2024; 19:340. [PMID: 38849937 PMCID: PMC11161947 DOI: 10.1186/s13018-024-04823-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Lumbar spondylolysis is a bone defect in the pars interarticularis of the lumbar vertebral, which is a common cause of low back pain in youth. Although non-surgical treatment is a mainstream option, surgery is necessary for patients with persistent symptoms. Buck technique is widely used as a classical direct repair technique, but it cannot achieve reduction of low-grade spondylolisthesis and reconstruction of lumbosacral sagittal balance. We have described a novel surgical procedure based on Buck technique with temporary intersegmental pedicle screw fixation, and report a series of clinical outcomes in 5 patients to provide a reference for the clinical treatment of young lumbar spondylolysis. METHODS Five young patients with symptomatic lumbar spondylolysis with a mean age of 19.20 ± 5.41 years underwent surgical treatment after an average of 7.60 ± 1.52 months of failure to respond to conservative treatment, using a new surgical procedure based on Buck technique combined with temporary intersegmental pedicle screw fixation. RESULTS Five patients were successfully operated without serious complications such as nerve and vascular injury. The average operation time was 109.00 ± 7.42 min, the interpretative average blood loss was 148.00 ± 31.14 ml, and the average fusion time was 11.20 ± 1.64 months. All patients were followed up for 2 years after surgery, and the visual analogue score (VAS) of low back pain and Oswestry disability index (ODI) scores were significantly improved compared with those before surgery, and the Henderson's evaluation were rated excellent or good. After the removal of the internal fixation, it was observed that temporary intersegmental fixation could repair the isthmus, reduce lumbar spondylolisthesis, and reconstruct the sagittal balance of the lumbosacral vertebrae while preserving lumbar motion and preventing intervertebral disc degeneration. Postoperative MRI indicated the Pfirrmann classification of the affected discs: 1 case from grade III to grade II, 3 cases from grade II to grade I, and 1 case remained grade II. CONCLUSIONS Buck technique supplemented by temporary intersegmental pedicle screw fixation is a highly applicable and effective method for the treatment of adolescent lumbar spondylolysis. The isthmic fusion is accurate, and temporary intersegmental fixation can effectively prevent disc degeneration and reconstruct the sagittal balance of lumbosacral vertebra.
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Affiliation(s)
- Yuchen Ye
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Huiwen Yang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Tao Ma
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Kun Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Gang Xu
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Zhongbing Han
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Zhili Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Nan Wu
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Xuan Guo
- The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
| | - Huanyu Li
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Pinghui Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Zhengqi Bao
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China
| | - Changchun Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical University, 287 Changhuai Road, Bengbu, 233004, China.
- Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical University, 2600 Donghai Road, Bengbu, 233030, China.
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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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Minor A, Klein BR, Sowah MN, Etienne K, Levi AD. Pars Interarticularis Fractures Treated with Minimally Invasive Surgery: A Literature Review. J Clin Med 2024; 13:581. [PMID: 38276087 PMCID: PMC10817087 DOI: 10.3390/jcm13020581] [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: 12/05/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
Recurrent stress on the isthmic pars interarticularis often leads to profound injury and symptom burden. When conservative and medical management fail, there are various operative interventions that can be used. The current review details the common clinical presentation and treatment of pars injury, with a special focus on the emerging minimally invasive procedures used in isthmic pars interarticularis repair. PubMed and Google Scholar database literature reviews were conducted. The keywords and phrases that were searched include but were not limited to; "history of spondylolysis", "pars interarticularis", "pars defect", "conventional surgical repair of pars", and "minimally invasive repair of pars". The natural history, conventional presentation, etiology, risk factors, and management of pars interarticularis injury are discussed by the authors. The surgical interventions described include the Buck's repair, Morscher Screw-Hook repair, Scott's Wiring technique, and additional pedicle screw-based repairs. Minimally invasive techniques are also reviewed, including the Levi technique. Surgical intervention has been proven to be safe and effective in managing pars interarticularis fractures. However, minimally invasive techniques often provide additional benefit to patients such as reducing damage of surrounding structures, decreasing postoperative pain, and limiting the time away from sports and other activities.
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Affiliation(s)
- Adrienne Minor
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA; (A.M.); (M.N.S.)
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (B.R.K.); (K.E.)
| | - Benjamin R. Klein
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (B.R.K.); (K.E.)
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43560, USA
| | - Mareshah N. Sowah
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA; (A.M.); (M.N.S.)
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (B.R.K.); (K.E.)
| | - Kayla Etienne
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (B.R.K.); (K.E.)
- School of Medicine, Tufts University, Boston, MA 02108, USA
| | - Allan D. Levi
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33146, USA; (B.R.K.); (K.E.)
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Tsukada M, Takiuchi T, Ichinoseki-Sekine N. Factors associated with return to play following conservative treatment for lumbar spondylolysis among young athletes: A retrospective case series using structural equation modeling. J Bodyw Mov Ther 2024; 37:51-56. [PMID: 38432841 DOI: 10.1016/j.jbmt.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 07/15/2023] [Accepted: 11/06/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Lumbar spondylolysis is the most common underlying cause of lower back pain (LBP) in young athletes. Conservative treatment methods are often used to reduce pain and promote healing. Several parameters may affect the duration of conservative treatment, such as the time to return to play (RTP), patient behavior, and physical parameters; however, no study has comprehensively assessed the factors that affect the time to RTP. OBJECTIVES This study aimed to determine the factors associated with the time required for RTP among young athletes with early-stage spondylolysis receiving conservative treatment using structural equation modeling (SEM). METHODS In this retrospective case series, 137 young athletes (128 males and 9 females, aged 9-18 years) with early-stage lumbar spondylolysis were enrolled. All patients were examined using plain radiography and magnetic resonance imaging and treated conservatively (sports cessation, wearing a corset, therapeutic exercises, and low-intensity pulsed ultrasound radiation). SEM was used to investigate the factors affecting the time to RTP in these patients. RESULTS The final model included the following factors: spondylolysis laterality, symptom duration, lower-extremity flexibility, treatment interval, patient adherence, and residual LBP. SEM revealed that patient adherence to physician orders (p < 0.01), treatment interval (p < 0.001), and spondylolysis laterality (p < 0.001) contributed directly to shortened RTP. CONCLUSION Patient adherence is essential for reducing the time to RTP among young athletes receiving conservative treatment for early-stage spondylolysis.
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Affiliation(s)
- Masahiro Tsukada
- Graduate School of Arts and Sciences, The Open University of Japan, Chiba, Japan; Department of Rehabilitation, Takiuchi Orthopedic and Sports Clinic, Sapporo, Japan.
| | - Toshiro Takiuchi
- Department of Orthopedic Surgery, Takiuchi Orthopedic and Sports Clinic, Sapporo, Japan
| | - Noriko Ichinoseki-Sekine
- Graduate School of Arts and Sciences, The Open University of Japan, Chiba, Japan; School of Health and Sports Science, Juntendo University, Inzai, Japan
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Lawrance SE, Boss E, Jacobs M, Day C. Current Clinical Concepts: Management of Common Lumbar Spine Posterior Column Disorders in Young, Active Individuals. J Athl Train 2022; 57:1021-1029. [PMID: 35788849 PMCID: PMC9875703 DOI: 10.4085/1062-6050-0161.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Although posterior column disorders, such as spondylolysis and spondylolisthesis, are not commonly encountered in the general population, athletic trainers frequently see these conditions in athletic and active individuals due to the repetitive spinal extension and rotational loads placed on the pars interarticularis while participating in sport. Athletic trainers can successfully evaluate patients with posterior column disorders by performing a complete and comprehensive clinical examination to identify the location of pain, test spinal stability, and recognize compensatory movement patterns. Conservative management typically leads to a successful outcome in this population, with rest, bracing, and the use of therapeutic exercise having the best supporting evidence. In this Current Clinical Concepts review, we outlined the etiology and risk factors frequently associated with disorders of the posterior column. Additionally, we synthesized the literature for common evaluation techniques and interventions associated with the posterior column and provided a proposed rehabilitation progression to use in a younger, athletic population.
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Affiliation(s)
- Scott E. Lawrance
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Emily Boss
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Meghan Jacobs
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Carly Day
- Department of Intercollegiate Athletics, Purdue University, West Lafayette, IN
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Ye Y, Jin S, Zou Y, Fang Y, Xu P, Zhang Z, Wu N, Zhang C. Biomechanical evaluation of lumbar spondylolysis repair with various fixation options: A finite element analysis. Front Bioeng Biotechnol 2022; 10:1024159. [DOI: 10.3389/fbioe.2022.1024159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: This study was designed to compare the biomechanical properties of lumbar spondylolysis repairs using different fixation methods by using three-dimensional finite element analysis.Methods: Five finite element models (A, B, C, D, and E) of L4-S1 vertebral body were reconstructed by CT images of a male patient (A: intact model; B: spondylolysis model; C: spondylolysis model with intrasegmental direct fixation by Buck screw; D: spondylolysis model with intersegmental indirect fixation by pedicle screw system; E: spondylolysis model with hybrid internal fixation). L5-S1 level was defined as the operative level. After the intact model was verified, six physiological motion states were simulated by applying 500 N concentrated force and 10 Nm torque on the upper surface of L4. The biomechanical properties of the three different internal fixation methods were evaluated by comparing the range of motion (ROM), maximum stress, and maximum displacement.Results: Compared with Model B, the ROM and maximum displacement of Model C, D, and E decreased. The maximum stress on L5/S1 disc in models A, B, and C was much higher than that in Model D and E under extension and lateral bending conditions. Under axial rotation and lateral bending conditions, the maximum stress of interarticular muscle and internal fixation system in Model B and Model C was significantly higher than that in Model D and Model E. In contrast to Model D, the stress in Model E was distributed in two internal fixation systems.Conclusion: In several mechanical comparisons, hybrid fixation had better biomechanical properties than other fixation methods. The experimental results show that hybrid fixation can stabilize the isthmus and reduce intervertebral disc stress, which making it the preferred treatment for lumbar spondylolysis.
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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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Byvaltsev VA, Kalinin AA, Shepelev VV, Pestryakov YY, Satardinova EE, Biryuchkov MY. [Results of the study of functional recovery of professional athletes after minimally invasive lumbar fusion]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:49-54. [PMID: 34932285 DOI: 10.17116/jnevro202112111149] [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: 11/17/2022]
Abstract
OBJECTIVE To conduct a comprehensive clinical-neurological assessment and to study the results of functional recovery of professional athletes after minimally invasive lumbar interbody fusion. MATERIALS AND METHODS The retrospective study included 27 patients-professional athletes who were operated on using minimally invasive decompression and stabilization techniques in the period 2010 to 2019. Clinical-neurological effectiveness was assessed when returning to previous sports activity was 14 (9; 17) weeks and 4 (3; 5) years after surgery. RESULTS The follow-up showed a significant improvement in clinical and neurological parameters: persistent elimination of radicular and muscular-skeletal symptoms, a decrease in the level of pain according to a visual analogue scale in the lumbar spine from 68 (61; 85) mm to 3 (2; 11) mm (p=0.002) and in the lower extremities from 84 (78; 91) mm to 1 (0; 3) mm (p=0.001), change in the physical component of health from 26.18 (23.58; 28.37) to 49.82 (49.03; 53.04) (p=0.002) and the psychological component of health from 27.87 (26.22; 29.29) to 52.18 (49.12; 55.66) (p=0.001), significant improvement in the perception of physical activity according to the Borg RPE Scale from 17 (16; 18) points to 9 (8; 9) (p<0.001). In one case (3.7%), the patient did not return to his previous sports career. CONCLUSION The use of minimally invasive rigid stabilization in the overwhelming majority of professional athletes made it possible in the shortest possible time to achieve regression of neurological symptoms, reduce pain, improve the quality of life, restore the functional state and return to previous sports activities.
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Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University, Irkutsk, Russia.,Clinical Hospital «Russian Railways-Medicine», Irkutsk, Russia.,Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia.,Clinical Hospital «Russian Railways-Medicine», Irkutsk, Russia
| | - V V Shepelev
- Irkutsk State Medical University, Irkutsk, Russia
| | | | - E E Satardinova
- Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - M Yu Biryuchkov
- Ospanov West Kazakhstan Medical University, Aktobe, Kazakhstan
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Zhang ZC, Zhang Y, Zhang LZ, Guan K, Zhao GM, Ren DJ, Li F, Sun TS. Repair of symptomatic bilateral L5 spondylolysis with autogenous iliac crest graft and temporary intersegmental pedicle screw fixation in youth. J Orthop Surg Res 2021; 16:422. [PMID: 34215290 PMCID: PMC8252200 DOI: 10.1186/s13018-021-02534-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/08/2021] [Indexed: 01/01/2023] Open
Abstract
Background When symptomatic spondylolysis fail to respond to nonoperative treatment, surgical management may be required. A number of techniques have been described for repair by intrasegmental fixation with good results; however, there are still some problems. We reported a repair technique with temporary intersegmental pedicle screw fixation and autogenous iliac crest graft. The aim of present study is to assess the clinical outcomes of L5 symptomatic spondylolysis with this technique. Methods A retrospective analysis of 128 patients with L5 spondylolysis treated with this method was performed. According to CT scan, the spondylolysis were classified into 3 categories: line, intermediate, and sclerosis type. The diagnostic block test of L5 bilateral pars defect was done in all patients preoperatively. The sagittal and axial CT images were used to determine the bone union. The healing time, complications, number of spina bifida occulta, Japanese Orthopedic Association (JOA) score, and VAS for back pain were recorded. After fixation removal, the rate of ROM preservation at L5S1 was calculated. Results There were 97 patients (194 pars) followed with mean follow-up of 23 months (range, 12–36 months). The union rate of pars was 82.0% at 12 months and 94.3% at 24 months postoperatively. Low back pain VAS significantly (P < 0.05) improved from preoperative mean value of 7.2 to 1.3 at the final follow-up postoperatively (P < 0.05). JOA score increased significantly postoperatively (P < 0.05) with average improvement rate of 79.3%. The rates of L5S1 ROM preservation were 79.8% and 64.0% after fixation removal at 1 and 2 years postoperatively. There were 3 patients of delayed incision healing without other complications. Conclusions Although sacrificing L5S1 segment motion temporarily, more stability was obtained with intersegmental fixation. This technique is reliable for spondylolysis repair which has satisfactory symptom relief, high healing rate, low incidence of complications, and preserve a large part of ROM for fixed segment.
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Affiliation(s)
- Zhi-Cheng Zhang
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Yang Zhang
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Li-Zhi Zhang
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Kai Guan
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Guang-Min Zhao
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Da-Jiang Ren
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Fang Li
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China.
| | - Tian-Sheng Sun
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
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Berger AA, Hasoon J, Urits I, Viswanath O, Lee A. Alleviation of Chronic Low Back Pain due to Bilateral Traumatic L4 Pars Interarticularis Fractures Relieved With Steroid Injections. Cureus 2020; 12:e9821. [PMID: 32953331 PMCID: PMC7495963 DOI: 10.7759/cureus.9821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Chronic back pain affects 20% of the adult population in the United States and is a significant source of disability and healthcare expenditure. One of the most common causes of chronic back pain is spondylosis. These changes result from age-related degeneration of the lumbar spine. As a result of this degeneration, spondylolisthesis can develop. Spondylolysis is a fracture of the pars interarticularis. It affects younger patients and is more prevalent in adolescents and elite athletes. It can be a debilitating condition that may force athletes into retirement as well as impair them with chronic pain and disability. Traditional treatment options include conservative management such as medications, rest, physical therapy, and rehabilitation. Surgery is reserved for patients who do not respond to conservative measures. Here we present the case of a 39-year-old mixed martial arts fighter with bilateral L4 pars interarticularis fractures and chronic low back pain. After failing conservative treatment options, this patient finally obtained significant relief with steroid injections at the level of the defect. The patient continues to do well with occasional injections and is able to maintain his mixed martial arts career. This case report provides evidence that injection therapy is a feasible alternative to surgery in patients who fail conservative therapy.
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Affiliation(s)
- Amnon A Berger
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Jamal Hasoon
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Ivan Urits
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Omar Viswanath
- Pain Management, Valley Pain Consultants - Envision Physician Services, Phoenix, USA
| | - Anthony Lee
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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