Prevalence of Symptomatic Lumbar Spondylolysis in Pediatric Patients

Abstract

Lumbar spondylolysis, a stress fracture of the pars interarticularis, is prevalent in adolescent athletes. Recent advances in diagnostic tools and techniques enable early diagnosis before these fractures progress to complete fractures through the pars. However, because patients often consult family physicians for primary care of low back pain and these physicians may not have access to diagnostic modalities such as magnetic resonance imaging (MRI) and computed tomography, stress fractures can be missed. This study surveyed the prevalence of symptomatic spondylolysis in pediatric patients who consulted an orthopedic clinic for primary care and investigated whether such acute stress fractures may be overlooked without MRI. The prospective study investigated 264 patients who were younger than 19 years and had low back pain. Of the 153 patients (58.0%) with low back pain persisting for longer than 2 weeks, 136 who agreed to undergo MRI were included in the study. This group included 11 elementary school students, 71 junior high school students, and 54 high school students. The overall prevalence of lumbar spondylolysis was 39.7% (54 of 136) and was 9.3% in elementary school students (5 of 11, 45.5%), 59.3% in junior high school students (32 of 71, 45.1%), and 31.5% in high school students (17 of 54, 31.5%). All 54 patients with spondylolysis had a history of athletic activity. Primary care physicians should recognize that approximately 40% of pediatric patients presenting with low back pain persisting for longer than 2 weeks may have spondylolysis and should consider MRI in those with a history of athletic activity. Because the spine is immature in this age group, almost half of affected elementary school and junior high school students may have lumbar spondylolysis. [Orthopedics. 2016; 39(3):e434-e437.].

Active stretching for lower extremity muscle tightness in pediatric patients with lumbar spondylolysis

“…Pars fracture, also known as lumbar spondylolysis, is the most prevalent disorder at this anatomic site in children and adolescents (1)(2)(3), as well as the apophyseal ring fracture (4,5). The pathogenesis of lumbar spondylolysis and apophyseal ring fracture is reported to involve stress fracture (6,7) or avulsion fracture (4,5), indicating that these disorders are caused by mechanical loading at the lumbar spine.…”

Temporal Evolution of Disc in Young Patients with Low Back Pain and Stress Reaction in Lumbar Vertebrae

“…S tress reaction in posterior elements of the lumbar spine is a common cause for low back pain in young athletes. [1][2][3][4][5][6][7][8][9][10][11] Whereas ongoing mechanical stresses can cause overt stress fractures and eventually spondylolisthesis, an initial microtrabecular bony injury within an affected pedicle or pars interarticularis manifests either as edema on MR imaging or as increased uptake on a bone scan. [2][3][4][5]12,13 Intervertebral discs attached to stressed vertebrae experience higher mechanical stresses, and even at a young age, these stressed discs demonstrate a higher burden of annular fissures, herniation, and loss of normal hyperintensity of the nucleus pulposus on T2WI.…”

Spondylolysis in Young Athletes: An Overview Emphasizing Nonoperative Management

“…In a radiographic study using computed tomography (CT) in 532 patients aged eight or younger presenting with general lumbar complaints, spondylolysis was diagnosed in 4.7% of the children. [1] e prevalence of lumbar spondylolysis in 153 pediatric patients, defined as younger than 19 years, who presented to an orthopedic clinic with low back pain for greater than two weeks was 39.7% [5]. All positive diagnoses of spondylolysis had a history of athletic participation.…”