Stress Fractures in the Spine and Sacrum

Micheli, Lyle J.; Curtis, Christine

doi:10.1016/j.csm.2005.08.001

Cited by 67 publications

(42 citation statements)

References 68 publications

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“…It has been previously postulated that in athletes, repetitive loading by hyperextension, twisting and axial forces of the [15][16][17][18][19]. Direct athletic contact activities play a primary role due to cyclic loading forces that may cause a fatigue fracture of the pars interarticularis [20,21].…”

Section: Pathogenesis and Incidence Of Spondylolysis And Lowgrade Olimentioning

confidence: 99%

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

Bouras

Korovessis

2014

Eur J Orthop Surg Traumatol

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Conservative treatment including physiotherapy and bracing is the mainstay in the treatment of symptomatic spondylolysis and low-grade isthmic spondylolisthesis in fine athletes. If consequent treatment fails, the operative treatment (pars repair and short fusion) is decided. Return to play following surgery varies from 6 to 12 months with prohibition in collision sports. Return to play is mostly depended on specific sport activity.

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Section: Pathogenesis and Incidence Of Spondylolysis And Lowgrade Olimentioning

confidence: 99%

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

Bouras

Korovessis

2014

Eur J Orthop Surg Traumatol

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“…12,16 The adolescent athlete, for example, belongs to a different subgroup than the young child because back pain in the adolescent more often results from acute injury or, more commonly, overuse injury. [22][23][24] …”

Section: Epidemiologymentioning

confidence: 99%

Imaging of Back Pain in Children

Rodriguez¹,

Poussaint²

2009

AJNR Am J Neuroradiol

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SUMMARY:While back pain presents less frequently in children than in adults, it still poses a significant clinical challenge with respect to making a firm diagnosis and developing an effective treatment plan. When children have back pain and medical attention is sought, an underlying pathology is usually suspected. Pediatric patients are evaluated, first, with a complete clinical history and examination and, second, by an imaging work-up that is based on initial findings, including the child's age and size, signs and symptoms, and suspected etiology. This article describes 1) the epidemiology of back pain in children, 2) the imaging work-up used, and 3) the correlation of imaging findings with disease entities that may cause back pain in the pediatric patient. The list of diseases giving rise to back pain is not meant to be exhaustive but rather reflective of the most commonly identified pathologies and disorders among young children and adolescents, from athletic injuries to lethal cancers.ABBREVIATIONS: ALARA ϭ as low as reasonably achievable; ESR ϭ erythrocyte sedimentation rate; FSE ϭ fast spin-echo; 18 F ϭ fluorine 18; LCH ϭ Langerhans cell histiocytosis; LDH ϭ lactate dehydrogenase; MBP ϭ mechanical back pain; PET ϭ positron-emission tomography; RFA ϭ radio-frequency ablation, SPECT ϭ single-photon emission computed tomography; STIR ϭ short tau inversion recovery; 99m Tc-MDP ϭ technetium 99m methylene diphosphonate; WHO ϭ World Health Organization B ack pain in children presents less frequently than in adults. The incidence of back pain in adults has been estimated to be as high as 60%-80% 1 ; the actual incidence of back pain in children, however, is unknown. Back pain in children presenting to the emergency department was originally thought to be an uncommon complaint, 2 reflecting significant underlying pathology compared with adults. Although recent studies have shown an increased prevalence of back pain in children, [3][4][5][6][7] relatively few patients receive medical attention.

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“…In a clinical study, 47% of 100 young athletes who presented with low-back pain were diagnosed with spondylolysis. 11 Jackson et al demonstrated an 11% incidence of spondylolysis among 100 female gymnasts. 8 Although the diagnosis of spondylolysis at the initial stage is difficult with plain radiographs and CT, MRI has been recently shown to be effective.…”

Section: Discussionmentioning

confidence: 99%

Adaptive remodeling at the pedicle due to pars fracture: a finite element analysis study

İnceoğlu

Mageswaran²,

Modic

et al. 2014

SPI

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Object Spondylolysis is a common condition among the general population and a major cause of back pain in young athletes. This condition can be difficult to detect with plain radiography and has been reported to lead to contralateral pars fracture or pedicle fracture in the terminal stages. Interestingly, some patients with late-stage spondylolysis are observed to have radiographic or CT evidence of a sclerotic pedicle on the side contralateral to the spondylolysis. Although computational studies have shown stress elevation in the contralateral pedicle after a pars fracture, it is not known if these changes would cause sclerotic changes in the contralateral pedicle. The objective of this study was to investigate the adaptive remodeling process at the pedicle due to a contralateral spondylolysis using finite element analysis. Methods A multiscale finite element model of a vertebra was obtained by combining a continuum model of the posterior elements with a voxel-based pedicle section. Extension loading conditions were applied with or without a fracture at the contralateral pars to analyze the stresses in the contralateral pedicle. A remodeling algorithm was used to simulate and assess density changes in the contralateral pedicle. Results The remodeling algorithm demonstrated an increase in bone formation around the perimeter of the contralateral pedicle with some localized loss of mass in the region of cancellous bone. Conclusions The authors' results indicated that a pars fracture results in sclerotic changes in the contralateral pedicle. Such a remodeling process could increase overall bone mass. However, focal bone loss in the region of the cancellous bone of the pedicle might predispose the pedicle to microfractures. This phenomenon explains, at least in part, the origin of pedicle stress fractures in the sclerotic contralateral pedicles of patients with unilateral spondylolysis.

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Stress Fractures in the Spine and Sacrum

Cited by 67 publications

References 68 publications

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

Imaging of Back Pain in Children

Adaptive remodeling at the pedicle due to pars fracture: a finite element analysis study

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