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

Abstract

: 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

Dash-Associated Spondylolysis Hypothesis

“…In this study, we found that 15% of our 10 patients with lumbar spondylolysis were track and field athletes, followed by baseball and 11 soccer players. This finding was proportionally high compared with previous studies that 12 reported a 7%-11% prevalence of lumbar spondylolysis in track and field athletes 9,10) , 13 thus suggesting that movements required during running may be involved in the 14 pathogenetic mechanism of spondylolysis in track and field athletes. 15…”

“…10 During a soccer game, maximal-and high-intensity sprints (Dash) by players are mixed 11 with moderate-and low-intensity running (Jog). In the 2014 World Cup, the mean number 12 of sprints per player in a soccer game was 33.25 ± 10.67 6) .…”

Characteristics of Adult-Onset Acute Lumbar Spondylolysis Treated Conservatively

“…6 in our study, the bone union rate and the treatment period did not differ so much between adolescents and adults. In a previous study 16) , patients with bilateral acute spondylolysis were excluded, and some patients exhibited pseudarthrosis lesions on the contralateral side, which negatively impacts bone union [17][18][19] ; these factors prevent simple comparisons between these studies. Nonetheless, for adult-onset acute spondylolysis with bone edema, conservative therapy is probably as effective as during adolescence with regard to achievement of bone union.…”

Bone Healing in Adolescents with Bilateral L5 Spondylolysis with and without Preexisting Contralateral Terminal Spondylolysis

“…Where bone healing was achieved with conservative treatment, Yamazaki et al [ 6 ] reported that bone healing rates where the contralateral side was progressive-stage and terminal-stage were 16.9% and 3.4%, respectively. Fujii et al [ 8 ] reported that the bone healing rate without contralateral defects or with contralateral early-stage spondylolysis was significantly higher than that for those with contralateral progressive or terminal-stage spondylolysis.…”

“…There is a possibility that this process progresses to lumbar spondylolisthesis, where a vertebra slips from its location to rest on the lower bone. There have been some reports that the pathological stage on the contralateral side can affect bone healing [6][7][8], but no reports have exclusively examined L5 spondylolysis.…”