Lumbar pars injury or spondylolysis – diagnosis and management

Debnath, Ujjwal K.; Harshavardhana, NS; Scammell, Brigitte E.; Freeman, Brian J. C.

doi:10.1016/j.mporth.2008.12.007

Cited by 4 publications

(2 citation statements)

References 72 publications

(101 reference statements)

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“…As much as 50 % of LBP in adolescent athletes is related to posterior element disturbance (PED) [ 20 ] , most often situated in the lower back segments L4 and L5 [ 23 ] . PED is considered to occur more frequently in some sports [ 4 ] . Boys are 3 times more aff ected than girls [ 18 ] , and if progression occurs, this tends to be more apparent during the growth spurt of puberty [ 24 ] .…”

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Clinical Examination, Spondylolysis and Adolescent Athletes

Sundell

Jonsson

Ådin³

et al. 2012

Int J Sports Med

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Symptomatic spondylolysis is a stress reaction caused by microtrauma during physical exercise, an imaging diagnostic subgroup of Adolescent Low Back Pain (ALBP), found in adolescent athletes. Early diagnosis increases the possibility of healing. Thus, it is important to divide ALBP into subgroups. The aim of this study was to evaluate clinical tests that can distinguish symptomatic spondylolysis from other forms of ALBP in order to facilitate early referral for diagnostic imaging. The investigation subjects were a prospective case series with a control group, 25 subjects with ALBP and 13 subjects that had no history of LBP. The 2 groups were examined using the same clinical protocol. MRI of the whole lumbar spine was performed in both the case and control groups and CT investigations of the L4 and L5 vertebrae were performed in the case group. Significant differences between the 2 groups were found in 8 of our clinical tests. No clinical test, alone or in combination, could distinguish between spondylolysis and other forms of ALBP. As 88% of the subjects in the case group had MRI findings and almost 50% had spondylolysis, MRI should be performed at an early age in young athletes with ALBP.

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Clinical Examination, Spondylolysis and Adolescent Athletes

Sundell

Jonsson

Ådin³

et al. 2012

Int J Sports Med

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“…In patients with spondylolysis who do not have pseudoarthrosis, conservative treatment, including physical therapy, activity modification, and bracing, are considered the primary forms of treatment and result in a successful bone union in many of these patients 1,2) . Surgical management may be required in those with pseudoarthrosis spondylolysis, which is not expected to progress to bone union, and when symptomatic spondylolysis fails to respond to conservative treatment 3) and affects the quality of life of young patients, particularly athletes 4) .…”

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Association of Pars Defect Type with Clinical Outcome after Smiley Face Rod Methods for Terminal-Stage Spondylolysis

Okuwaki,

Tatsumura,

Gamada

et al. 2024

Spine Surg Relat Res

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Background:The smiley face rod method is an effective treatment for symptomatic terminal-stage spondylolysis. However, the risk factors for treatment failure are unknown. We investigated the association of pars defect type with the treatment outcomes of this method. Methods:We retrospectively examined data from 34 patients (18.0 ± 6.7 years) with terminal-stage spondylolysis who underwent surgery using the smiley face rod method.The mean follow-up period was 44.9 ± 21.4 months. The patients were divided into 2 groups: pars defect without bone atrophy or sclerosis (group A; 18 patients), and with bone atrophy and sclerosis (group B; 16 patients). We defined atrophy as a defect with a depression in the defect line that causes the defect to expand and the edge to become asymmetrical. We evaluated and compared the visual analog scale (VAS) score for back pain, bone union rate, and time to return to preinjury level athletics between the groups.Fisher exact and paired Student t tests were used to compare the variables between groups. The VAS score between the groups was compared using a 2-factor repeatedmeasures analysis of variance.Results: Within groups, the VAS score was significantly different over time (p < 0.001). The VAS scores between groups were not significantly different. Patients in Group A had a significantly higher bone union rate per pars at 6 months (group A, 65.7%; and group B, 37.5%, p = 0.028) and 24 months after surgery (group A, 97.1%; and group B, 75.0%, p = 0.011). All patients returned to their respective sports, and no significant differences were observed in the time to return to preinjury level athletics between the groups (p = 0.055). Conclusion:Pars sclerosis defects are associated with bone nonunion, but have little

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