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. 2018 Nov;13(2):105-109.
doi: 10.2185/jrm.2967. Epub 2018 Nov 29.

Prevalence of curable and pseudoarthrosis stages of adolescent lumbar spondylolysis

Masaki Tatsumura  1 , Hisanori Gamada  1 , Ryu Ishimoto  1 , Shun Okuwaki  1 , Fumihiko Eto  1 , Takeshi Ogawa  1 , Takeo Mammoto  1 , Atsushi Hirano  1
Affiliations

Prevalence of curable and pseudoarthrosis stages of adolescent lumbar spondylolysis

Masaki Tatsumura et al. J Rural Med. 2018 Nov.

Abstract

Objective: The aim of this study was to determine the prevalence of curable and pseudoarthrosis stages of adolescent lumbar spondylolysis under high school students complaining of and seeking medical consultation for low back pain. Patients and Methods: We analyzed age, sex, morbidity, presence of spina bifida occulta (SBO), and competitive sport discipline of patients with lumbar spondylolysis. We then stratified their pathological stage using a modified classification system via magnetic resonance imaging and computed tomography. Results: Of 507 patients, 451 lesions in 268 patients were diagnosed with lumbar spondylolysis (average age, 14.7 years; sex ratio, 215:53 male/female). Morbidity levels were as follows: L1, 1 lesion in 1 patient; L2, 9 lesions in 5 patients; L3, 38 lesions in 25 patients; L4, 106 lesions in 74 patients; L5, 297 lesions in 189 patients, and SBO verified in 111 patients. A total of 264 patients played a specific sport: baseball, 93; soccer, 49; volleyball, 21; track and field, 21; basketball, 20; others, 164. The prevalence of curable- and pseudoarthrosis-stage lumbar spondylolysis was 206 lesions in 142 patients, and 141 lesions in 87 patients, respectively. Conclusion: With 59.3% of patients having curable-stage lumbar spondylolysis, adolescent athletes with low back pain are urged to seek consultation. Furthermore, clinicians should perform magnetic resonance imaging to avoid misdiagnosis.

Keywords: adolescent; lumbar spondylolysis; pseudoarthrosis; stage.

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Figures

Figure 1
Figure 1
Axial slice classification. (a, b) Pre-lysis stage: no fracture line visible on CT, but bone marrow edema present on MRI. (c, d) Early stage: partial gap on CT, and bone marrow edema on MRI. (e, f) Progressive stage: clear gap on CT, and bone marrow edema on MRI. (g, h) Terminal stage: defect on CT, but no bone marrow edema on MRI. CT, computed tomography; MRI, magnetic resonance imaging. Figures a, c, e and g were taken with CT, and Figures b, d, f and h were taken with MRI.
Figure 2
Figure 2
Sagittal slice classification. (a, b) Stage 0: no fracture line visible on CT, but bone marrow edema visible on MRI. (c, d) Stage 1a: partial bone absorption on CT, and bone marrow edema on MRI. (e, f) Stage 1b: partial fracture line less than half of lamina thickness on CT, and bone marrow edema on MRI. (g, h) Stage 1c: partial fracture line more than half of lamina thickness on CT, and bone marrow edema on MRI. (i, j) Stage 2: penetrated fracture line on CT, and bone marrow edema on MRI. (k, l) Stage 3: penetrated fracture line on CT, but no bone marrow edema on MRI. CT, computed tomography; MRI, magnetic resonance imaging.
Figure 3
Figure 3
(a) Age distribution showing two peaks at 13 and 16 years of age. (b) Sex ratio showing male cases being four times more likely than female cases.
Figure 4
Figure 4
Distribution by vertebral level: (a) number of cases and (b) number of lesions.
Figure 5
Figure 5
Distribution by sport.
Figure 6
Figure 6
Distribution based on axial slice classification.
Figure 7
Figure 7
Distribution based on sagittal slice classification.
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