Conservative Treatment for Bony Healing in Pediatric Lumbar Spondylolysis

Sakai, Toshinori; Tezuka, Fumiaki; Yamashita, Kazuo; Takata, Yoichiro; Higashino, Kosaku; Nagamachi, Akihiro; Sairyo, Koichi

doi:10.1097/brs.0000000000001931

Cited by 71 publications

(76 citation statements)

References 15 publications

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“…A higher defect stage for contralateral pars interarticularis was also identified as a negative predictive factor of bone union in athletes with spondylolysis. The results showed that bony union rate was 84.2% in the very early stage, 88.4% in the early stage, and 37.1% in the progressive stage, which were low compared with previous study (9). In our study, the patients with very early stage pars defect, who could not achieve bone union had terminal contralateral pars defect or early return to sports in less than 60 days.…”

Section: Discussioncontrasting

confidence: 42%

“…Sys et al also found that healing was complete in all athletes with unilateral lesions, in five out of nine athletes with bilateral lesions, and in none of the athletes with pseudobilateral lesions (25). Moreover, patients with acute spondylolysis were reported to be likely to achieve bone union with conservative therapy for three months, compared to those with chronic spondylolysis (8,9). …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, we found that not only higher defect stage and contralateral defect but also body flexibility was a negative predictive factor of bone union in athletes with spondylolysis. Previous studies suggested that bone union was more likely to occur in very early, early, and progressive spondylolysis stages (8)(9)(10). Several studies recommended stretching hamstrings during conservative treatment of spondylolysis and preservation of hamstring flexibility to prevent LBP (6,13,23).…”

Section: Discussionmentioning

confidence: 99%

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High defect stage, contralateral defects, and poor flexibility are negative predictive factors of bone union in pediatric and adolescent athletes with spondylolysis

Yamazaki¹,

Kota²,

Oikawa³

et al. 2018

J. Med. Invest.

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: Purpose : To identify predisposition to spondylolysis and physical characteristics associated with "bone union" following conservative spondylolysis treatment among pediatric and adolescent athletes. Methods : We retrospectively analyzed pediatric and adolescent athletes with spondylolysis who underwent conservative treatment and rehabilitation for three or more consecutive months following sports activity cessation. Patients with terminal spondylolysis or who did not discontinue sports activities were excluded. We compared physical fitness factors in the union and nonunion groups and examined the association between bone union and spondylolysis severity by logistic regression analysis. Results : Of 183 patients with spondylolysis who underwent rehabilitation over a four-year period, 127 patients with 227 defects were included in the final analysis. Bone union was achieved in 66.5% % (151/227) of the pars interarticularis defects and 70.1% % (89/127) of the patients. On multivariate analysis, stage of pars interarticularis defect (odds ratio [OR], 0.26 ; p = 0.0027), stage of contralateral pars interarticularis defect (OR, 0.51 ; p = 0.00026), and straight leg -raising test (OR, 1.06 ; p = 0.028) were significantly associated with bone union. Conclusions : High defect stage, stage of the contralateral pars interarticularis defect, and poor flexibility were negative prognostic factors of bone healing in athletes with spondylolysis. J. Med. Invest. 65 : 126-130, February, 2018

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Section: Discussioncontrasting

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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High defect stage, contralateral defects, and poor flexibility are negative predictive factors of bone union in pediatric and adolescent athletes with spondylolysis

Yamazaki¹,

Kota²,

Oikawa³

et al. 2018

J. Med. Invest.

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“…Lumbar spondylolysis (LS) is a disorder in which stress fractures occur at the lumbar spine and is frequently identified in adolescent athletes (1,2). Early diagnosis and conservative treatment is essential for bone healing (3,4). Recent advances in radiology and accumulation of clinical experience in the treatment of LS have improved the outcomes in pediatric patients with the condition (5 -7).…”

Section: Introductionmentioning

confidence: 99%

“…Biomechanical studies have shown that extension and/or rotation of the lumbar spine concentrates stress on the pars interarticularis, which can lead to a stress fracture, that is, LS, at this site (8). Conservative treatment, including rest, cessation of physical activity, and use of a thoraco -lumbo -sacral brace, is recommended until the fracture has healed, and favorable outcomes have been reported (3,4). However, some patients are refractory to conservative treatment and others develop further stress fractures when they resume physical activity (3).…”

Section: Introductionmentioning

confidence: 99%

Physical features of pediatric patients with lumbar spondylolysis and effectiveness of rehabilitation

Iwaki¹,

Sakai

Hatayama³

et al. 2018

J. Med. Invest.

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The purpose of this study was to evaluate the physical features of pediatric patients with lumbar spondylolysis (LS), factors that increase the load during compensatory movements at the lumbar spine, and the outcomes of rehabilitation. Twenty patients were included. Fifteen items were used : fingertip-to-floor distance (FFD), straight leg raising (SLR), heel-to-buttock distance (HBD), tightness of the rectus femoris, the lateral and medial rotator muscles, iliopsoas, tensor fascia lata, adductor muscles, soleus muscle, and latissimus dorsi, and trunk rotation, sit-ups and endurance of the abdominal and back muscles. Initial findings were judged as positive or negative using previously reported cut-off values and were re-evaluated 2 or 3 months later. Positive tests were found for HBD and tightness of the rectus femoris in 85% % of the patients, for endurance of the abdominal muscles in 75% %, SLR and sit-ups in 70% %, and FFD and tightness of the external rotator muscles in 60% %. The physical features varied according to the type of sport played, and some patients were refractory to rehabilitation. Only 17.6% %, 33.3% %, and 40.0% % of patients with initially positive findings for HBD, tightness of the external rotator muscles, and endurance of the abdominal muscles, respectively, achieved improvements after rehabilitation.

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