Characteristics of adolescent lumbar spondylolysis with acute unilateral fatigue fracture and contralateral pseudoarthrosis

Masaki Tatsumura; Shun Okuwaki; Hisanori Gamada; Fumihiko Eto; Katsuya Nagashima; Sho Iwabuchi; Takeshi Ogawa; Takeo Mammoto; Atsushi Hirano

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Characteristics of adolescent lumbar spondylolysis with acute unilateral fatigue fracture and contralateral pseudoarthrosis

VernacularTitle:Characteristics of adolescent lumbar spondylolysis with acute unilateral fatigue fracture and contralateral pseudoarthrosis
Author: Masaki TATSUMURA ¹ ; Shun OKUWAKI ² ; Hisanori GAMADA ² ; Fumihiko ETO ¹ ; Katsuya NAGASHIMA ¹ ; Sho IWABUCHI ¹ ; Takeshi OGAWA ¹ ; Takeo MAMMOTO ¹ ; Atsushi HIRANO ¹
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1. Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Japan
2. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
Keywords: lumbar spondylolysis; union rate; contralateral pseudoarthrotic lesion; treatment failure; adolescent
From:Journal of Rural Medicine 2020;15(4):170-177
CountryJapan
Language:English
Abstract: Purpose: This study aimed to examine the characteristics of lumbar spondylolysis with acute lumbar spondylolysis on one side and pseudoarthrotic spondylolysis on the other, relative to acute lumbar spondylolysis on one side only.Patients and Methods: Short-tau inversion recovery images obtained through magnetic resonance imaging were used to diagnose 58 patients with acute lumbar spondylolysis with bone marrow edema on one side only. A total of 20 patients who had pars defects on the contralateral side (terminal-stage pseudoarthrotic spondylolysis) were included in the contralateral pseudoarthrosis group (P group). The remaining 38 patients with normal images for the contralateral pars interarticularis were included in the unilateral lesion group, in which the contralateral side was normal (U group). We investigated the union rate, age, sex, lesion laterality, vertebral level, pathological stage, and existing spina bifida occulta in both groups.Results: The P group was characterized by a higher proportion of right-side cases, L5 lesions, more progressed pathological stage, and spina bifida occulta and a significantly lower union rate than the U group.Conclusion: The union rate in patients with lumbar spondylolysis with acute lumbar spondylolysis on one side and pseudoarthrotic spondylolysis on the opposite side was only 15%. We should inform patients with acute unilateral spondylolysis lesions and contralateral pseudoarthrosis about this poor union rate and urge them to choose their therapy accordingly.