Clinical characteristics of early-stage lumbar spondylolysis detected by magnetic resonance imaging in male adolescent baseball players

Kato, Kinshi; Otoshi, Kenichi; Kono, Kenji; Kaneko, Yota; Nakazawa, Shigeshi; Konno, Satoshi

doi:10.1016/j.jos.2022.10.014

Cited by 5 publications

(2 citation statements)

References 28 publications

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“…A recent review in the sport of baseball found that laterality in pain that lasted for over 4 weeks, which interfered with running and with spinous process tenderness were the characteristics most associated with spondylolysis. [33]…”

Section: Use Of Bracingmentioning

confidence: 99%

Management of lumbar bone stress injury in cricket fast bowlers and other athletes

Orchard,

Saw,

Kountouris

et al. 2023

SA J Sports Med

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Background: Recent guidelines (including a special series in The Lancet) have emphasised a minimal role for imaging when assessing low back pain in adults, as the majority of patients will have non-specific findings on imaging that do not correlate well with pain. Objective: To assess whether the diagnosis of lumbar bone stress injuries in young athletes should be considered an exception to the recommendation to avoid imaging for low back pain in adults. Method: Narrative review. Results: Early lumbar bone stress injury diagnosis has been available via traditional MRI sequences (and its precursor Single Photon Emission Computed Tomography (SPECT)) for 25-30 years. MRI assessments using bone window sequences (such as Volumetric Interpolated Breath-hold Examination (VIBE)) have allowed a better understanding of the diagnosis and prognosis of lumbar bone stress injury in young athletes. MRI with bone sequences has allowed non-radiating scans to serially follow the healing of unilateral stress fractures. In the majority of cases, non-chronic unilateral fractures can heal; however, this takes three-six months rather than the six-ten weeks that would be the typical unloading period if using symptoms (only) as a guide. The use of MRI to provide evidence of bony healing (as opposed to fibrous union, which creates the pars defect that predisposes to further bone stress lesions) can lead to better long-term outcomes in athletes. There is evidence to flag this as a structural lesion which is both painful and, more importantly, can heal/resolve if managed correctly. Therefore it represents an important ‘specific’ diagnostic subset within adult low back pain. Conclusion: Structural (rather than functional) management of bone stress injuries in high-demand athletes, such as cricket pace bowlers, is in contrast to the recommendation of functional management for general back pain in adults. Structural management is justified when there are demonstrable superior outcomes of having better structure. Although this has not yet been shown in randomised trials of elite athletes, apparent lengthier Test cricket careers of pace bowlers who do not have pars defects suggest better athletic outcomes if bony healing is achieved. For lower demand young adults, or athletes with established bilateral pars defects, functional management may be more pragmatic.

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Section: Use Of Bracingmentioning

confidence: 99%

Management of lumbar bone stress injury in cricket fast bowlers and other athletes

Orchard,

Saw,

Kountouris

et al. 2023

SA J Sports Med

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show abstract

“…Clinical findings that are significantly related to early stage spondylolysis are identified as ≥4 weeks of LBP duration, interference with running, LBP starting with laterality and spinous process tenderness. 20 Every patient must be thoroughly inspected, and the gait must be observed. The most frequent inspection finding is lumbar hyperlordosis.…”

Section: Spondylolysis and Spondylolisthesismentioning

confidence: 99%

Management of low back pain accompanying sagittal plane pathologies in children: Spondylolysis/spondylolisthesis and Scheuermann’s disease

Cetik,

Latalski,

Yazici

2023

Journal of Children's Orthopaedics

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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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Effect of lumbar lordosis angle on the development of lumbar spondylolysis in adolescent baseball players: A cross-sectional study

Onoda,

Kitagawa

2023

Journal of Orthopaedic Science

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Clinical characteristics of early-stage lumbar spondylolysis detected by magnetic resonance imaging in male adolescent baseball players

Cited by 5 publications

References 28 publications

Management of lumbar bone stress injury in cricket fast bowlers and other athletes

Management of lumbar bone stress injury in cricket fast bowlers and other athletes

Management of low back pain accompanying sagittal plane pathologies in children: Spondylolysis/spondylolisthesis and Scheuermann’s disease

Effect of lumbar lordosis angle on the development of lumbar spondylolysis in adolescent baseball players: A cross-sectional study

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