Is Spondylolysis a Fatigue Fracture?

Hutton, W. C.; Stott, J. R. R.; Cyron, B M

doi:10.1097/00007632-197709000-00006

Cited by 74 publications

(21 citation statements)

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“…Previous research has shown that bilateral spondylolytic defects in patients are much more likely to progress to spondylolisthesis and subsequent disc degeneration [11,26,49]. The general conclusions provided from such studies, along with the results we obtained, support the notion that the expected amount of degenerative disc disease in a patient with bilateral pars defects at a given level, should exceed that of someone without those lesions.…”

Section: Discussionsupporting

confidence: 84%

Bilateral Pars Defects at the L4 Vertebra Result in Increased Degeneration When Compared With Those at L5: An Anatomic Study

McCunniff

Yoo

Dugarte

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Cadaveric studies have examined disc degeneration at the L4-L5 and L5-S1 motion segments; however, we are not aware of another study that has examined the relationship between bilateral spondylolysis and its effect on degenerative disc disease at those levels. This may have been overlooked by researchers owing to the majority of spondylolysis occurring at the L5 vertebra. Questions/purposes Using osteologic specimens from a collection that included individuals who died in one city in the USA between 1893 and 1938, we asked: (1) do specimens with bilateral spondylolysis (bilateral pars defects) have increased levels of disc degeneration, at their respective motion segments, when compared with matched controls without spondylolysis, and (2) is the finding of a bilateral pars defect associated with more severe arthritis at L4-L5 than at L5-S1? Methods An observational study was performed on 665 skeletal lumbar spines from the Hamann-Todd Osteologic Collection at the Cleveland Museum of Natural History (Cleveland, OH, USA). The specimens included 534 males and 131 females ranging from 17 to 87 years old, with a nearly bell-shaped distribution of ages for males and a larger proportion of younger ages in the female specimens. Of those with spondylolysis, 81 had a defect at L5 and 14 had a defect at L4. The gross specimens were examined subjectively for evidence of arthrosis. At the time of examination, specific attention was not paid to the coexisting presence or absence of spondylolysis nor was the examiner blinded to the age of the specimens. Disc degeneration was measured by the classification of Eubanks et al., a modified version of the Kettler and Wilke classification. Linear regression was performed to derive a formula that would predict the amount of disc degeneration at L4-L5 and L5-S1 for the normal control population given a specimen's age, sex, and race. We then used this formula to evaluate the difference in disc degeneration at the corresponding level of the pars defect that is greater Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the University Hospitals Case Medical Center and the Cleveland Museum of Natural History, Cleveland, OH, USA. P. T. McCunniff (&), Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® than the pr...

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Section: Discussionsupporting

confidence: 84%

Bilateral Pars Defects at the L4 Vertebra Result in Increased Degeneration When Compared With Those at L5: An Anatomic Study

McCunniff

Yoo

Dugarte

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Biomechanically, the facet joints share load mainly in compression and extension of the lumbar spine [1]. They furthermore protect the disc from excessive rotational strain and anterior shear forces [2,15]. It therefore has been argued that more sagittal alignment of the joint leads to anterior gliding due to a reduced resistance to anterior shear forces [10,24].…”

Section: Discussionmentioning

confidence: 99%

Facet joint remodeling in degenerative spondylolisthesis: an investigation of joint orientation and tropism

Berlemann

Jeszenszky

Bühler

et al. 1998

European Spine Journal

103

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IntroductionSeveral studies have attempted to define etiological factors for the development of degenerative spondylolisthesis (DS), and the orientation of lumbar facet angles relative to the transverse plane has been a major focus of interest. The facet joints play a critical role in maintaining stability of the lumbar spine by sharing load in compression and extension, and protecting the disc from excessive shear and rotational forces [1,13,24]. Determined by their spatial orientation, they also guide motion between two adjacent vertebrae. Their oblique orientation in the lumbar spine allows flexion, extension, and lateral bending, but only a small amount of axial rotation [27].It has been shown that in patients with DS, the facet joints are significantly more sagittally oriented, thus allowing the superior vertebra to glide anteriorly. Individuals with sagittally oriented facet joints have therefore been regarded as candidates for DS [23]. However, it is not clear whether this more pronounced sagittal orientation of the facet joint represents a pre-existing morphology or whether it has to be considered a result of secondary remodeling.Facet joint asymmetry (tropism) has been claimed to be related to disc herniation and degenerative disc disease due to rotational instability of the spinal segment [6,8,20]. Whether facet joint tropism plays a role in the development of DS, however, has not been investigated.The present study analyzed facet joint orientation in the transverse plane in patients with DS and compared this to patients with no evidence of ventrolisthesis from three different age groups. The working hypothesis was that if the more sagittal orientation in DS was a pre-existing anatomical feature, it then should be possible to identify a younger patient group being "at risk" for the development of DS later in life. The incidence of facet joint tropism in the different groups was also investigated.Abstract This study analyzed transverse facet joint angulations at the three lower lumbar levels in 132 patients assigned to one of four groups. Group A comprised 23 patients with degenerative spondylolisthesis (DS) at the level L4-5, group B comprised 40 patients above the age of 50 years, group C comprised 38 patients aged between 35 and 50 years, and group D comprised 31 patients under the age of 35 years. Groups B, C, and D had no evidence of DS. Measurements were taken from hard copies of axial MR or CT images. The transverse plane of facet joints was more sagittally oriented in group A than in any other group. This difference was highly significant at the L4-5 level. The incidence of more sagittally oriented L4-5 facet joints was also significantly higher only in group A. The incidence of facet joint tropism, however, was not different in group A. These results support the view that the pronounced sagittal alignment of facet joints in patients with DS represents a secondary remodeling rather than a pre-existing morphology. Facet joint asymmetry does not seem to play a major role in the development of DS.

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“…The classic picture of spondylolysis is complete separation (lysis) through pars interarticularis (the isthmus between the superior and inferior articular processes), and the vertebrae most commonly affected are the lower lumbar, especially L5. Although the term is descriptive, not aetiologic, and rare cases have been attributed to acute trauma (Gérard, 1962;Smith et al, 1977;Cope, 1988) or defective development (Verhaak, 1974;Miki et al, 1991;Polly & Mason, 1991), lower lumbar spondylolysis is generally produced by fatigue or stress fracturing, with the stress produced by movement of the affected vertebra relative to the vertebra below (Wiltse et al, 1975;Cyron et al, 1976;Hutton et al, 1977;Cyron & Hutton, 1978).…”

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confidence: 99%

Spondylolysis in Inuit skeletons from Arctic Canada

Merbs

2002

Intl J of Osteoarchaeology

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Inuit skeletons from archaeological sites in Arctic Canada were examined for the presence of spondylolysis. The largest series represent the Thule culture and historic Inuit from northwest Hudson Bay and Labrador, and Sadlermiut from Southampton Island. The condition was found in 90 individuals, with a total of 120 affected vertebrae producing 198 hemi-arch defect sites.As in other studies, L5 is affected most frequently, followed by L4 and L3, but examples of L1, L2, L6, and S1 involvement are represented. Incomplete separations account for 20% (40) of the 198 defects, and 5% (10) occur at sites other than interarticularis. Affected males outnumber females at a ratio of 2.4 to 1. The condition was found to increase in frequency from adolescence to young adulthood, and then decrease to middle adulthood and decrease again to old adulthood, but the drop in frequency with age in the adult categories is significant only at the .20 level. Where comparisons could be made, the data obtained from the Canadian Inuit closely resemble those obtained from Alaskan Eskimos and Aleuts, especially their closest linguistic relatives, Inupiat speakers in northern Alaska.

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Is Spondylolysis a Fatigue Fracture?

Cited by 74 publications

References 0 publications

Bilateral Pars Defects at the L4 Vertebra Result in Increased Degeneration When Compared With Those at L5: An Anatomic Study

Bilateral Pars Defects at the L4 Vertebra Result in Increased Degeneration When Compared With Those at L5: An Anatomic Study

Facet joint remodeling in degenerative spondylolisthesis: an investigation of joint orientation and tropism

Spondylolysis in Inuit skeletons from Arctic Canada

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