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Background: Lumbar spondylolysis is a common cause of low back pain in adolescents. A lot of adolescent idiopathic scoliosis with concomitant spondylolysis has been reported before, but only two cases with acquired spondylolysis following long fusion for scoliosis were reported. We described another similar rare case and discussed its causes and treatment options in this paper., Case Presentation: A 17-year-old female underwent growing rod implantation, growing rod extension, and final long spinal fusion for idiopathic scoliosis. Then, she suffered from low back pain with a VAS of 1-2 points and gradually aggravated to a VAS of 7-8 points at 3.5 years after the final fusion. The X-ray images showed that there was L4-S1 instability. And the CT scan images showed new bilateral spondylolysis of L5., Conclusions: These findings suggested that distal mechanical stress might cause spondylolysis of the distal vertebra following long fusion for scoliosis. Surgeons should keep instrumentation as short as possible and avoid choosing a low lumbar as LIV when they decide on the fusion levels., (© 2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

The anatomy and pathogenesis of spondylolysis has been widely studied; however, the microanatomy of spondylolysis of the lumbar vertebra has not been well described. Therefore, we aim to better elucidate this anatomy. Twenty dry bone specimens of healed and unhealed spondylolysis of the L5 vertebra were collected from human skeletal remains. Twelve L5 vertebrae were examples of unhealed spondylolysis and eight specimens exhibited a healed (i.e., bony fusion of the lesion) spondylolysis lesion. The specimens underwent macro and microanatomical analysis followed by CT and microCT imaging. Finally, selected healed and unhealed lesions were submitted for histological analysis using Mason Trichrome staining. The pars interarticularis of two L5 vertebrae without signs of healed/unhealed spondylolysis were evaluated histologically as controls. Of the 12 unhealed L5 pars defects, three were unilateral on left side. Of the eight healed pars defects, all were unilateral and seven of these were on left sides. One unilateral pars defect also had spina bifida occulta. Both on imaging and histological analysis, healed pars defects were only so superficially and not at deeper levels. Histologically, unhealed edges were made up of dense cortical bone while healed edges were made up primarily of trabecular bone. Based on our anatomical findings, the so-called healed spondylolysis lesions, although externally fused, are not thoroughly fused internally. Moreover, the anterior and posterior edges of the unhealed spondylosysis lesions are irregular and show signs of long-term disarticulation. Taken together, these data suggest that such 'healed' lesions might not be as stable as the normal L5 pars interarticularis., (© 2023 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Lumbar spondylosis, though mostly occurs at pars interarticularis of vertebrae, it rarely occurs at articular processes. Like the ones in pars interarticularis, articular process fractures are stress fractures that are usually seen in people participated in active sprts activity. Most of the time, nonoperative treatment is adequate. When conservative treatment fails, removal of fragments accomplishes pain relief. In this report, we present a case with bilateral spondylolysis of inferior articular processes at 3rd lumbar vertebrae and discuss with regards to the literature.

Introduction: Spondylolysis and isthmic spondylolisthesis are commonly implicated as organic causes of low back pain in this population. Many patients involved in sports that require repetitive hyperextension of the lumbar spine like diving, weightlifting, gymnastics and wrestling develop spondylolysis and isthmic spondylolisthesis. While patients are typically asymptomatic in mild forms, the hallmark of symptoms in more advanced disease include low back pain, radiculopathy, postural changes and rarely, neurologic deficits., Methods: We conducted a narrative review of the literature on the clinical presentation, diagnosis, prognosis and management of spondylolysis and isthmic spondylolisthesis., Results: A comprehensive physical exam and subsequent imaging including radiographs, CT and MRI play a role in the diagnosis of this disease process. While the majority of patients improve with conservative management, others require operative management due to persistent symptoms., Conclusion: Due to the risk of disease progression, referral to a spine surgeon is recommended for any patient suspected of having these conditions. This review provides information and guidelines for practitioners to promote an actionable awareness of spondylolysis and isthmic spondylolisthesis., Competing Interests: Conflicts of interest: None., (© Copyright by the American Board of Family Medicine.)

Background: Patients who do not respond to conservative treatment of the isthmus are often treated with surgery. We used direct repair plus intersegment pedicle screw fixation for the treatment of lumbar spondylolysis. The aim of this observational study was to assess the effects of this technique and evaluate various risk factors potentially predicting the probability of disc and facet joint degeneration after instrumentation., Methods: The study included 54 male L5 spondylolysis patients who underwent pars repair and intersegment fixation using pedicle screws. Bony union was evaluated using reconstruction images of computed tomography. Radiographic changes, including disc height, vertebral slip, facet joint and disc degeneration in the grade of adjacent and fixed segments, were determined from before to final follow-up. Logistic regression analysis was performed to identify factors associated with the incidence of disc and facet joint degeneration., Results: Bony union was achieved in all cases. Logistic regression analysis revealed that instrumentation durations of greater than 15.5 months and 21.0 months were significant risk factors for the incidence of L4/5 and L5S1 facet degeneration, respectively., Conclusions: Intersegmental pedicle screw fixation provides good surgical outcomes and good isthmic bony union rates in patients with lumbar spondylolysis. The duration of fixation was confirmed as a risk factor for facet joint degeneration. Once bony union is achieved, instrument removal should be recommended., (© 2022. The Author(s).)

Background: Spondylolysis is a defect in the pars interarticularis of the vertebra that occurs frequently in high-performance young athletes. Although nonsurgical management is the mainstay of treatment, surgery is an option for patients with persistent symptoms despite multiple cycles of nonsurgical treatment. Performing a minimally invasive technique reduces complications, postsurgery pain, and hospitalization time and leads to a quick recovery. The aim of this study was to report the clinical results of a series of 3 patients treated with a modification of the Buck technique with a minimally invasive approach., Methods: Three high-performance athletes between 17 and 18 years old who were managed nonsurgically for at least 6 months underwent a modified Buck technique repair with a minimally invasive approach using cannulated compression screws, with neuronavigation and neuromonitoring. Patients were followed at least 6 months with computed tomography scans to assess consolidation and fixation status. Following rehabilitation and in the absence of pain, all 3 athletes returned to their respective sports. No complications were reported., Results: All patients presented with bilateral spondylolysis, at L3 in 1 case and at L5 in 2 cases. Patients received conservative management for 12-36 months before surgery. After surgery, consolidation was obtained at 4 months in all patients, who returned to their sports activities in <6 months., Conclusions: The proposed technique shows the advantages of performing minimally invasive surgery in young high-performance athletes, ensuring consolidation and early return to sports activity without complications., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Rationale: For isthmic lumbar spondylolisthesis (ILS) associated with the removal of herniation, it remains challenging to perform less invasive and minimally disruptive procedures. Good results could potentially be obtained by further preserving the posterior elements in full-endoscopic lumbar discectomy (FESS), which is less invasive than microenscopic surgery (MES)., Patient Concerns: One patient complained of left leg pain, and another patient complained of right leg pain and low back pain., Diagnoses: Two patients with ILS and Meyerding Grade 1 lumbar spondylolisthesis., Interventions: We performed a full-endoscopic lumbar discectomy via the interlaminar space (FESS-IL) for L5/S1 lumbar disc herniation (LDH) accompanied by isthmic lumbar spondylolisthesis. FESS-IL was performed in 2 patients with radiculopathy caused by different types of LDH using a full endoscopic system with a 4.1 mm working channel and 6.9 mm outer diameter. A 3.5-mm diameter high-speed drill was used in one patient for an upward-migrated LDH in the inner-rim of the infravertebral border. The other patient underwent minimal resection without bone resection., Outcomes: The one-year clinical outcome included confirmation of pain relief and evacuation of migrated LDH on magnetic resonance imaging in all patients. There was no progression of slippage on radiography. The mean operative time was 82 min, and no complication was observed. The one-year clinical outcome demonstrated sufficient pain relief., Lessons the Y: ear postoperative outcome showed improvement. We believe that FESS-IL is a viable alternative operative approach for LDH for ILS., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Three types of sacral alar fatigue fractures are elderly, postnatal, and sport-related. They are most prevalent in athletes during adulthood; there are few reports of sacral alar fatigue fractures in young athletes. The purpose of this study was to analyze sacral alar fatigue fractures in adolescent athletes. Of the 920 patients hospitalized with low back pain, 13 were diagnosed with sacral alar fatigue fractures with magnetic resonance imaging (MRI) abnormalities. We investigated age, sex, sports discipline, span from symptom onset to consultation, laterality, complication with spondylolysis, computed tomography (CT) findings, and treatment span. The average age was 14.5 years old (8-men and 5-women). The most frequent discipline was basketball. The span to consultation was 13.2 days. The number of right-side cases was 9. Seven cases were complicated by bilateral spondylolysis. MRI abnormalities were observed in all the cases. Only two patients showed abnormal findings on CT. Averagely 67 days after treatment, participants returned to their sports. Sacral alar fatigue fractures suggest that the span from onset to consultation is short. Fracture lines are often unclear on CT, and MRI is useful for diagnosis. More than half of the cases in this study were complicated by lumbar spondylolysis.

Background: Spondylolysis is the main cause of low back pain (LBP) in young athletes. There are few studies analyzing the difference of spondylolysis among young athletes with different sports activities. The purpose of this study was to compare the clinical factors and distribution of the lesions of spondylolysis on magnetic resonance imaging (MRI) scans in young soccer and baseball players with symptomatic spondylolysis., Methods: The medical records of 267 young athletes aged 7 to 18 years old who underwent MRI to evaluate the cause of LBP between 2017 and 2020 were retrospectively reviewed to identify patients with spondylolysis. Of the young athletes with symptomatic spondylolysis, clinical factors and MRI findings in soccer and baseball players were retrospectively evaluated. The clinical factors were age, sex, interval from onset of LBP to MRI, and side of the dominant leg in the sports field. MRI findings included number, lumbar level, and side of the lesions., Results: A total of 33 soccer players (mean age, 15.4 ± 1.4 years) and 49 baseball players (mean age, 15.4 ± 1.6 years) with symptomatic spondylolysis were enrolled. All patients were male. No significant differences were noted in age and the interval from onset of LBP to MRI between the groups. Soccer players had greater numbers of multiple (p < 0.001) and bilateral (p < 0.001) lesions than baseball players. The dominant side of the hand for pitching or batting was correlated with the contralateral-side lesions in baseball players (p = 0.001)., Conclusions: The distribution of the lesions of spondylolysis differed in young soccer and baseball players. Pitching or batting with the dominant-side hand would be associated with contralateral-side lesions in baseball players. Sports-specific movements and the side of the dominant leg should be considered when treating young athletes with symptomatic spondylolysis.

Confusion persists over pathogenesis of spondylolysis. To confirm pathogenicity of the previously identified causative mutation of spondylolysis and investigate the genetic etiology, we generate a new mouse line harboring D673V mutation in the Slc26a2 gene. D673V mutation induces delayed endochondral ossification characterized by transiently reduced chondrocyte proliferation in mice at the early postnatal stage. Adult D673V homozygotes exhibit dysplastic isthmus and reduced bone volume of the dorsal vertebra resembling the detached vertebral bony structure when spondylolysis occurs, including the postzygopophysis, vertebral arch, and spinous process, which causes biomechanical alterations around the isthmic region of L4-5 vertebrae indicated by finite element analysis. Consistently, partial ablation of Slc26a2 in vertebral skeletal cells using Col1a1-Cre; Slc26a2 fl/fl mouse line recapitulates a similar but worsened vertebral phenotype featured by lamellar isthmus. In addition, when reaching late adulthood, D673V homozygotes develop an evident bone-loss phenotype and show impaired osteogenesis. These findings support a multifactorial etiology, involving congenitally predisposed isthmic conditions, altered biomechanics, and age-dependent bone loss, which leads to SLC26A2-related spondylolysis., (© 2019 Federation of American Societies for Experimental Biology.)

Objective: To assess the risk of spondylolysis by sport in nonelite adolescent athletes with low back pain (LBP)., Design: Retrospective case series., Setting: Hospital-based sports medicine clinic., Patients: The medical charts of 1025 adolescent athletes with LBP (age 15 ± 1.8 years) were examined; 308 (30%) were diagnosed with a spondylolysis., Assessment of Risk: Risk of spondylolysis was assessed in 11 sports for males and 14 sports for females., Main Outcome Measure: Relative risk of diagnosis of spondylolysis injury., Results: The risk of spondylolysis differed by sex with baseball (54%), soccer (48%), and hockey (44%) having the highest prevalence in males and gymnastics (34%), marching band (31%), and softball (30%) for female athletes. Baseball was the only sport to demonstrate a significant increased risk of spondylolysis., Conclusions: The sports with the greatest risk of spondylolysis in adolescent athletes in this study were not consistent with published literature. Clinicians should be cautious generalizing high-risk sports to their practice, as geographic region and level of the athlete may significantly influence the incidence of spondylolysis in the population they are treating.

Acquired spondylolysis represents an uncommon complication of spine surgery, of an unknown incidence and etiology. We studied patients presenting this rare entity, with the purpose to investigate the incidence, imaging findings, patients' clinical characteristics, as well as to provide an interpretation of the mechanisms that may lead to this phenomenon. The presented working hypothesis, regarding etiology, suggests that there is a relation between variations in spinopelvic sagittal alignment and acquired spondylolysis. Between January 2010 and January 2015, six patients presented spondylolysis after short-segment transforaminal lumbar interbody fusion, at a mean time of 43 months after surgery. The preoperative intactness and postoperative defect of pars interarticularis were documented with computed tomography scans in all patients. Standard radiographical spinopelvic parameters were measured before and after surgery. The optimum values of lumbar lordosis (LL) and pelvic incidence minus lumbar lordosis modifier (PI-LL mismatch) were calculated as well. The incidence of acquired spondylolysis was 0.95% among patients with short-segment lumbar fusion. Patients presented high-grade PI with a vertically orientated sacral endplate, while LL was found 9° greater and PI-LL mismatch 9° lower than the respective optimum values, indicating a non-harmonized alignment. In conclusion, acquired spondylolysis, though rare, may occur in patients with high-grade PI and sacral slope, and suboptimal spinopelvic sagittal alignment after lumbar spine surgery, thereby highlighting the importance of detailed preoperative planning in spine surgery, along with the study of sagittal balance.

Purpose: To study the risks of spondylolysis due to extrinsic loading conditions related to sports activities and intrinsic spino-pelvic postural parameters [pelvic incidence (PI) and sacral slope (SS)]., Methods: A comprehensive osseo-disco-ligamentous L4-S1 finite element model was built for three cases with spondylolysis representing three different spino-pelvic angular configurations (SS = 32°, 47°, 59° and PI = 49°, 58°, 72°, respectively). After simulating the standing posture, 16 dynamic loading conditions were computationally tested for each configuration by combining four sport-related loads (compression, sagittal and lateral bending and axial torque). For each simulation, the Von Mises stress, L5-S1 facet contact force and resultant internal loads at the sacral endplate were computed. Significant effects were determined with an ANOVA., Results: The maximal stress and volume of cancellous bone in the pars with stress higher than 75% of the ultimate stress were higher with 900 N simulated compression (2.2 MPa and 145 mm 3 ) compared to only the body weight (1.36 MPa and 20.9 mm 3 ) (p < 0.001). Combined compression with 10 Nm of flexion and an axial torque of 6 Nm generated the highest stress conditions (up to 2.7 MPa), and L5-S1 facet contact force (up to 430 N). The maximal stress was on average 17% higher for the case with the highest SS compared to the one with lowest SS for the 16 tested conditions (p = 0.0028)., Conclusions: Combined flexion and axial rotation with compression generated the highest stress conditions related to risks of spondylolysis. The stress conditions intensify in patients with higher PI and SS. These slides can be retrieved under Electronic Supplementary Material.

Study Design: This study was a case series., Objective: The purpose of this paper was to present a case series of fresh stress fractures (spondylolysis) in the lumbar spines of adult athletes., Summary of Background Data: Lumbar spondylolysis is a stress fracture of the pars interarticularis, which is generally considered a disease of children or adolescence. There is only 1 case series written in English reporting on adult-onset fresh spondylolysis., Methods: Eleven patients aged 20-27 years are included in this case series. A retrospective analysis was made of events that may cause stress fracture such as traumatic episodes or sports activities, spinal level, radiologic findings, stage of spondylolysis, treatment, and prognosis., Results: Among the 11 patients, two had bilateral early-stage spondylolysis, 7 had unilateral early-stage spondylolysis and 2 had unilateral progressive-stage spondylolysis. Three occurred subsequent to a preexisting terminal-stage spondylolysis in the contralateral side, 1 occurred subsequent to a terminal-stage spondylolysis at the adjacent spinal level, and 1 occurred subsequent to a terminal-stage spondylolysis at a distant level. Thirteen pedicles adjacent to the pars interarticularis in the 11 patients showed bone marrow edema-like signal on magnetic resonance imaging. Six spondylolyses were found at L5, 2 each at L3 and L4, and 1 spondylolysis at L2. The 11 patients were divided into 4 groups according to suspected pathogenic mechanism: preexistent spondylolysis in the contralateral side, alteration of the athletic event, apparent traumatic episode, and others. Conservative treatment was prescribed for return to sports in all cases. Although 1 patient retired because of persistent low back pain, the remaining 10 patients returned to competition., Conclusions: Although lumbar spondylolysis is generally recognized to occur in childhood or adolescence, fresh lumbar spondylolysis should be included in the differential diagnosis of adult low back pain when patients are high-level athletes. Conservative treatment should be attempted for adult patients.

Osteogenesis imperfecta is a genetic disorder of type I collagen. Although multiple genotypes and phenotypes are associated with osteogenesis imperfecta, approximately 90% of the mutations are in the COL1A1 and COL1A2 genes. Osteogenesis imperfecta is characterized by bone fragility. Patients typically have multiple fractures or limb deformity; however, the spine can also be affected. Spinal manifestations include scoliosis, kyphosis, craniocervical junction abnormalities, and lumbosacral pathology. The incidence of lumbosacral spondylolysis and spondylolisthesis is higher in patients with osteogenesis imperfecta than in the general population. Use of diphosphonates has been found to decrease the rate of progression of scoliosis in patients with osteogenesis imperfecta. A lateral cervical radiograph is recommended in patients with this condition before age 6 years for surveillance of craniocervical junction abnormalities, such as basilar impression. Intraoperative and anesthetic considerations in patients with osteogenesis imperfecta include challenges related to fracture risk, airway management, pulmonary function, and blood loss.

Introduction: Spondylolysis is a common occurrence for adolescent athletes who have low back pain. The injury involves a defect in the pars interarticularis, occurring as a result of repeated hyperextension and rotation., Clinical Presentation: Clinical findings might include tightness of the hip flexors and hamstrings, weakness of the abdominals and gluteals, and an excessive lordotic posture. The validity of several clinical tests were compared alongside magnetic resonance imaging, but were not able to distinguish spondylolysis from other causes of low back pain. Medical referral should be arranged so that medical imaging and diagnostic testing can be completed to insure a proper diagnosis., Interventions: Initial intervention includes rest from sport, which may vary from 2 weeks to 6 months. Bracing is also used to help minimize lumbar lordosis and lumbar extension. Exercises that focus on stabilization and spine neutral position should be incorporated in physical therapy intervention. Avoiding end ranges is important while performing exercises to minimize the translational and rotational stresses on the spine. Surgical interventions have also been recommended for athletes who have had persistent low back pain for more than six months with no relief from rest and bracing., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: Lumbar spondylolysis, a stress fracture of the pars interarticularis in the lumbar spine, is often precipitated by trauma, but there may be a congenital predisposition to this condition. There have been few studies on spondylolysis in young children, despite their suitability for studies on congenital defects. The aim of this study was to identify the clinical features of lumbar spondylolysis in elementary school age children in order to elucidate its pathogenesis., Methods: Thirty lumbar spondylolysis patients (23 boys, 7 girls, including a pair of twins; mean age 9.5 years, age range 5-12 years) were studied. Patient data on history of athletic activity, symptoms at first consultation, and radiological findings such as spinal level, stage of the stress fracture, and skeletal age were collected., Results: Among the 30 patients, 27 (21 boys, 6 girls) had L5 spondylolysis (90.0 %). Only 2 patients had no history of athletic activity at the first consultation. All patients, except for 2 whose diagnosis was incidental, complained of low back pain. In the 27 patients with L5 spondylolysis, 17 (63.0 %) had terminal-stage fracture and 25 (92.6 %) had spina bifida occulta (SBO) involving the S1 lamina. Sixteen of the 27 (59.3 %) had SBO involving the affected lamina (L5) and S1 lamina. In contrast, the 3 patients with L3 or L4 spondylolysis had no evidence of SBO. With respect to skeletal age, 23 of the 27 L5 spondylolysis patients (85.2 %) were in the cartilaginous stage while the remaining 4 patients were in the apophyseal stage., Conclusion: Lumbar spondylolysis in elementary school age children was commonly a terminal-stage bone defect at L5, which was not necessarily related to history of athletic activity and was sometimes asymptomatic. It was often associated with SBO, indicating a possible congenital predisposition. These findings may provide further insight into the pathogenesis of lumbar spondylolysis.

Spondylolysis, a defect or stress fracture of the vertebral pars interarticularis, occurs most frequently in the lower lumbar spine and occasionally in the cervical spine, but is extremely rare in the thoracic spine. We report the case of a 17 year-old girl, an elite rhythmic gymnast, who reported with early-stage thoracic spondylolysis at T10 and T11 levels. Physicians should be aware that performance of unusual athletic movements, such as those by gymnasts, may lead to spondylolysis in rare locations.

Objective: To provide evidence-based data about the aetiology, incidence, diagnosis and treatment of isthmic lumbar spondylolysis and low-grade spondylolisthesis and return to athletic activities in fine athlete., Design: This is a comprehensive literature review. A thorough MEDLINE search in the period from 1973 to 2014 with the keywords: athlete, spondylolysis, low-grade spondylolisthesis, treatment and return to athletic activities was conducted., Results: A total of 228 articles were initially enrolled from the search, and 74 case series and reviews were finally included because they referred to incidence, diagnosis, treatment and return to play in fine athletes with symptomatic isthmic spondylolysis and low-grade (Meyerding I and II) spondylolisthesis. There were 13 studies reporting surgical treatment (194 patients of average age 19 years) and 14 studies with conservative treatment (589 patients of average age 15.7). The percentage of athletes who were successfully treated with conservative or operative treatment was 85 and 87.8%, respectively., Conclusion: 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.

Background: Although pole vaulting has been a sanctioned collegiate event since the 1920s, little is known about the injury patterns observed in the sport., Purpose: To describe injury incidence, patterns, and risks in collegiate pole vaulters., Study Design: Descriptive epidemiology study., Methods: This was a prospective cohort study of collegiate athletes participating in pole vault over a single track-and-field season. Baseline athlete information was collected on study enrollment. Injuries were recorded in a standardized form to document diagnosis and event circumstances. A log of practice and competition exposures was maintained for each athlete. Injury incidence was reported as the proportion of injured vaulters and number of new injuries per 1000 athlete-exposures. Regression analysis on baseline variables was performed to determine risks for injury., Results: A total of 135 vaulters from 15 universities took part in the study. There were 70 injury events reported during 8823 exposures. Forty-one percent of vaulters sustained injury, and there were 7.9 injuries per 1000 athlete-exposures. The low back was the most common injury location (16.7%), followed by the hamstrings and lower leg (13.9% each). Overall, 60% of injuries were to the lower extremities, 21% to the upper extremities, and 18% to the back. No head or neck injuries were reported. Injuries were most commonly muscular strains (39.2%) or overuse type (25.5%). Thirty percent, including 83% of low back injuries, occurred during the plant/takeoff phase of the vault. One-third of lumbar injuries were spondylolysis, with 75% of these being season ending. The odds of injury were 2.7 (95% CI, 1.1-7.1) times greater in vaulters with multiple prior injuries., Conclusion: This is the first prospective study of injury patterns in collegiate pole vaulters. The results indicate that injuries are very common in experienced vaulters. Medical personnel and coaches should be aware of the propensity for overuse-type injuries and institute activity modification to reduce time lost. In addition, coaches and athletes should focus on proper technique, particularly during the plant/takeoff to help minimize back injury. Medical providers should maintain a high level of suspicion for symptomatic spondylolysis in any vaulter complaining of frequent or persistent low back pain. Detailed medical histories are important to identify prior injuries, and coaches should focus on changing technical flaws or behaviors that may contribute to reinjury., (© 2015 The Author(s).)

Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses to spondylolisthesis (forward slippage of the vertebral body). This slip progression is prevalent in children and occurs very rarely after spinal maturation. The pathomechanism and predilection for children remains controversial despite considerable clinical and basic research into the disorder over the last three decades. Here we review the pathomechanism of spondylolytic spondylolisthesis in children and adolescents, and specifically the Tokushima theory of growth plate slippage developed from our extensive research findings. Clinically, we have observed the slippage site near the growth plate on MRI; then, using fresh cadaveric spines, we found the weakest link against forward shear loading was the growth plate. We subsequently developed an immature rat model showing forward slippage after growth plate injury. Moreover, finite element analysis of the pediatric spine clearly showed increased mechanical stress at the growth plate in the spondylolytic pediatric spine model compared with the intact pediatric spine. Thus, spondylolysis progresses to spondylolisthesis (forward slippage) in children and adolescents with the growth plate as the site of the slippage. Repetitive mechanical loading on to the growth plate may serve to separate the growth plate and subsequently progress to spondylolisthesis.

Background Context: Cervical spondylolysis (CS) is a rare condition and is even more uncommon in pediatric patients. It is characterized by a disruption of the articular mass at the junction of the superior and inferior facet joints and often is diagnosed incidentally. The C6 level is most commonly involved, and the cause of CS remains unknown. There are no recommendations in the literature regarding activity modification in patients with CS and no discussion as to risks of participation in American football or other contact sports., Purpose: To report a case of C6 bilateral cervical spondylolysis with bicuspid spinous process and to discuss radiographic/clinical findings and issues related to participation in contact sports and minimizing the risk of spinal cord injury., Study Design/setting: Case report with 6 months clinical/radiographic follow-up, Methods: Radiographic description, clinical findings, and current review of the literature., Results: A pediatric patient presented with a bilateral C6 cervical spondylolysis and bicuspid spinous process after an American football-related minor cervical spine trauma. Findings on radiographs indicated that the spondylolysis appeared to be chronic in nature, without evidence of instability. The patient and his family were educated on ways to decrease the risk of spinal cord injury with contact sports, after which the patient was allowed to participate fully in sports without restrictions or adverse events., Conclusion: Pediatric cervical spondylolysis is a rare condition, the cause of which remains debated. Although there is theoretical risk, more than 1.5 million youth participate in American football annually, and there have been no reported cases of significant spinal cord injury in patients with CS from football or other contact sports., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to assess athletic activities associated with spondylolysis in children and adolescents in a New York metropolitan tertiary referral center., Methods: We retrospectively evaluated 137 consecutive cases of symptomatic spondylolysis presenting to one of two pediatric orthopedic spine surgeons. Ten patients who did not participate in any organized athletics were excluded, leaving 127 children for analysis. Data regarding spondylolysis and athletic participation were gathered for analysis., Results: One hundred and twenty-seven patients were analyzed (mean age, 13.9 ± 2.2 yr). All patients had initial x-rays, with nearly all obtaining further advanced level imaging to confirm the diagnosis of spondylolysis. Magnetic resonance imaging was obtained in 42.5% of cases, limited computed tomography scan in 29.1% of cases, and single-photon emission computed tomography scan in 23.6% of cases. The most common location of spondylolysis was at the L5 level (74%), of which 43.6% were bilateral. Of the overall cohort, 2.4% had spondylolysis at multiple levels. The most common athletic activities associated with spondylolysis in this cohort were soccer (19.3%), basketball (17.2%), and lacrosse (9.4%)., Conclusion: Although previous reports have implicated participation in various sports in the development of symptomatic spondylolysis in children, lacrosse and baseball have rarely been associated with spondylolysis. We found that in the New York metropolitan area, soccer, basketball, lacrosse, baseball, tennis, and football were most commonly associated with spondylolysis. Therefore, we emphasize consideration of spondylolysis in these children if they present with low back pain. These results may be used to counsel parents and young athletes about the possibility of spondylolysis as an etiology of lumbar back pain and in educating coaches, teachers, school nurses, and primary care providers.

Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR.

Purpose: This study aimed to analyze lumbo-pelvic lateral flexion kinematics and kinetics in junior fast bowlers and compare bowlers with varying quadratus lumborum (QL) cross-sectional area (CSA) asymmetry profiles., Methods: Magnetic resonance imaging was used to determine QL CSA of 39 participants who also underwent three-dimensional analysis of their bowling action., Results: Bowlers with greater than 10% QL asymmetry (n = 26) experienced a larger peak lumbo-pelvic lateral flexion; angle (21.6° ± 4.2°), angular velocity (314.9°·s ± 86.6°·s), moment (12.8 ± 2.5 N·m·kg·m), positive power (25.6 ± 12.6 W·kg·m), and negative power (48.6 ± 20.9 W·kg·m) compared with the bowlers with less than 10% asymmetry (n = 13) (angle = 18.1° ± 1.9°, angular velocity = 243.8°·s ± 64.9°·s, moment = 10.4 ± 2.8 N·m·kg·m, positive power = 14.7 ± 7.4 W·kg·m, and negative power = 33.8 ± 17.7 W·kg·m; P < 0.05)., Conclusion: Fast bowlers with QL CSA asymmetry in excess of 10% experience increased lumbo-pelvic lateral flexion loads during bowling. As increased lateral flexion loads may increase the risk of spondylolysis development, the presence of large QL asymmetry may be a useful screening tool for identifying bowlers at risk of developing lumbar spondylolysis.

Study Design: A retrospective case series., Objective: The purpose of this study was to describe a unique group of intercollegiate athletes who are skeletally mature and who developed symptomatic acute lumbar spondylolysis and to study long-term return to play outcome of nonoperative and surgical repair of L3 and L4 spondylolysis in skeletally mature athletes., Background: Traditionally, symptomatic acute lumbar spondylolysis is a defect found in skeletally immature athletes, most commonly in the pars interarticularis of L5, less commonly in the L3/L4 region, and even less commonly in skeletally mature athletes as described in this group., Methods: Eight intercollegiate athletes (2 women and 6 men, ages ranging from 19 to 21 y) with acute lumbar spondylolysis were diagnosed by means of computed tomography (CT) and single photon emission-CT bone scan. L3 lesions were present in 5 patients, and L4 lesions were present in 3 patients. All patients were treated initially nonoperatively with a protocol of bracing and activity modification. The healing progress was assessed through repeat CT scan. Patients who failed to respond to nonoperative procedures underwent direct repair of their pars defect through variable angle pedicle screw and sublaminar hook. Outcomes were measured by completion of the Oswestry Low Back Pain Disability Questionnaire (mean follow-up 6.5 y) and return to athletic participation., Results: All patients successfully returned to full athletic competition. Two patients showed radiographic healing and resolution of pain following 3 months of nonoperative treatment. Five patients required surgical repair of the pars defect. All of these patients eventually returned to unrestricted participation in athletics., Conclusions: This study shows that this subgroup will generally respond well to surgical correction of the pars defect and return to uninhibited competition following conservative treatment and/or surgical repair.

Study Design: Retrospective study., Objective: To determine if 25-hydroxyvitamin D (25[OH]D) level measurement and bone mineral density (BMD) using dual-energy x-ray absorptiometry (DXA) are indicated in children with a history of stress fracture of the pars interarticularis., Summary of Background Data: Healing rates of 4%-25% for bilateral and unilateral pars fractures, respectively, have previously been reported. Factors that may contribute to osteomalacia, rickets, and poor bone healing include low (25[OH]D) and low BMD., Methods: Patients were seen at the Nebraska Spine Center between 2008 and 2010. Selection criteria included a diagnosis of pars fracture with DXA Z-score values (lumbar and hip) and pretreatment serum (25[OH]D) level measurement. Twenty-four patients were included. Vitamin D was defined as sufficient when ≥ 32 ng/mL, insufficient when 20 to < 32 ng/mL, and deficient when < 20 ng/mL. BMD was interpreted from DXA Z-scores using reference intervals defined in the literature. A Z-score <-2.0 was considered low for chronological age., Results: The mean (± SD) vitamin D level was 29.9 ng/mL ± 10.8 (range, 9-56 ng/mL). Values were ≤ 10 ng/mL in 1 patient (4%), 11-20 ng/mL in 4 patients (17%), 21-30 ng/mL in 8 patients (33%), 31-50 ng/mL in 10 patients (42%), and > 50 ng/mL in 1 patient (4%). This correlated to 3 (13%) patients with deficient vitamin D (≤ 15 ng/mL), 12 (50%) patients with insufficient levels, and 9 (38%) with sufficient levels of vitamin D. The mean Z-scores were 0.43 ± 0.93 (lumbar, range, -1.3 to 2.8) and 1.0 ± 1.11 (hip, range, -0.5 to 3.0). All scores were consistent with normal bony mineralization for age., Conclusions: On the basis of these data, we recommend routine vitamin D testing and do not recommend routine DXA in adolescents with lumbar stress fractures of the pars interarticularis.

Study Design: A cross-sectional magnetic resonance imaging (MRI) study., Objective: We investigated the association among Modic changes, Schmorl's nodes, spondylolytic defects, high-intensity zone lesions, radial tears, herniations, and low back symptom severity., Summary of Background Data: Disc degeneration is associated with low back pain in early adulthood, but the associations between other MRI findings and low back pain are not well known., Methods: Questionnaire data and MRI scans (1.5-T) were available for 554 subjects derived from a birth cohort at 21 years of age. Data on low back pain and back-related functional limitations at 18, 19, and 21 years of age were used for clustering of subjects, using latent class analysis. We used logistic regression with adjustment for the degree of disc degeneration to evaluate the associations between specific imaging findings and low back symptom severity., Results: The prevalence of herniations was 20%, Schmorl's nodes 17%, radial tears 9.9%, high-intensity zone lesions 3.2%, spondylolytic defects 5.8%, and Modic changes 0.7%. Latent class analysis produced 5 clusters: "Always Painful" (n = 65) meant painful at all time points and "Recent Onset Pain" (n = 56) meant increasing symptom severity, whereas subjects in the "Moderately Painful" (n = 73), "Minor Pain" (n = 193), and "No Pain" (n = 167) clusters had fewer symptoms. Compared with the "No Pain" cluster, Schmorl's nodes were more likely to occur in the "Always Painful" cluster (P = 0.017) and herniations in the 3 most painful clusters (P < 0.001). Herniations were associated with low back symptom severity (odds ratio, 2.5; 95% confidence interval, 1.4-4.4). Schmorl's nodes and radial tears were associated with symptoms in crude analyses only, whereas high-intensity zone lesions and spondylolytic defects occurred in similar frequencies in all clusters., Conclusion: Herniations were most likely in the subjects with recent onset or persistent (3-yr period) low back symptoms, although they were also detected in subjects with no symptoms. The clinical relevance of herniations on MRI remains to be evaluated in the context of symptoms.

Background Context: Lumbar spondylolysis is a well-recognized condition occurring in adolescents because of repetitive overuse in sports. Multiple-level spondylolysis involving consecutive lower lumbar segments are rare. Several authors have reported failure of conservative treatment in the management of multiple-level pars fractures., Study Design: A case report and review of previous literature is presented., Objective: The objectives of this case report were to present a rare case of pars fracture involving nonconsecutive segments and discuss image findings and treatment., Methods: The patent's history, clinical examination, computed tomography (CT), magnetic resonance imaging (MRI) findings, and treatment are reported. We also discuss the pathogenesis, various treatment options, and review the literature., Results: We present the fourth case of bilateral pars fractures involving nonconsecutive lower lumbar spine segments of L3 and L5, in a 16-year-old young adolescent footballer who presented with 4-month history of constant low back pain. After 1 year of conservative management, the more acute fractures at L3 showed complete bony union, symptomatic pain relief, and return to full sporting activity., Conclusion: We report a rare case of bilateral pars fractures involving nonconsecutive segments. Multiplane reconstruction of CT images and MRI are very useful in planning treatment and follow-up. Conservative management may be used to treat multilevel nonconsecutive pars fractures., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Object: Athletes present with back pain as a common symptom. Various sports involve repetitive hyperextension of the spine along with axial loading and appear to predispose athletes to the spinal pathology spondylolysis. Many athletes with acute back pain require nonsurgical treatment methods; however, persistent recurrent back pain may indicate degenerative disc disease or spondylolysis. Young athletes have a greater incidence of spondylolysis. Surgical solutions are many, and yet there are relatively few data in the literature on both the techniques and outcomes of spondylolytic repair in athletes. In this study, the authors undertook a review of the surgical techniques and outcomes in the treatment of symptomatic spondylolysis in athletes., Methods: A systematic review of the MEDLINE and PubMed databases was performed using the following key words to identify articles published between 1950 and 2011: "spondylolysis," "pars fracture," "repair," "athlete," and/or "sport." Papers on both athletes and nonathletes were included in the review. Articles were read for data on methodology (retrospective vs prospective), type of treatment, number of patients, mean patient age, and mean follow-up., Results: Eighteen articles were included in the review. Eighty-four athletes and 279 nonathletes with a mean age of 20 and 21 years, respectively, composed the population under review. Most of the fractures occurred at L-5 in both patient groups, specifically 96% and 92%, respectively. The average follow-up period was 26 months for athletes and 86 months for nonathletes. According to the modified Henderson criteria, 84% (71 of 84) of the athletes returned to their sports activities. The time intervals until their return ranged from 5 to 12 months., Conclusions: For a young athlete with a symptomatic pars defect, any of the described techniques of repair would probably produce acceptable results. An appropriate preoperative workup is important. The ideal candidate is younger than 20 years with minimal or no listhesis and no degenerative changes of the disc. Limited participation in sports can be expected from 5 to 12 months postoperatively.

Background: Spondylolysis and spondylolisthesis are common abnormalities of the lumbar spine. The incidence of these diagnoses is recognized in the healthy population. However, their incidence in osteogenesis imperfecta (OI) patients is less well defined., Methods: This is a retrospective radiographic review of patients treated in the OI clinic from a single institution. Lateral radiographs were reviewed on all available patients to assess the incidence of spondylolysis and spondylolisthesis in this patient population. The morphology of the pedicle and pars interarticularis was also evaluated to identify any abnormalities or dysplasia of these structures., Results: One hundred ten of the 139 patients treated in the OI clinic met the inclusion criteria for this study. Of these patients, 79% (87 of 110) were ambulatory. The overall incidence of spondylolysis in this pediatric OI population was found to be 8.2% (9 of 110) at an average age of 7.5 years. The incidence of spondylolisthesis was 10.9% (12 of 110) at an average age of 6.5 years with 75% (3 of 12) being isthmic type and 25% (3 of 12) dysplastic. The combined incidence of spondylolysis and spondylolisthesis was 19.2%. Incidentally, the pedicle length was noted to be elongated in 40.0% (44 of 110) of this OI population., Conclusions: This study found that the incidence of spondylolysis in a group of children with OI was much higher than in the normal pediatric population, which has been reported to be 2.6% to 4.0%. This incidence was also found to be higher than previously reported incidence of spondylolysis in OI patients (5.3%). The incidence of spondylolisthesis was also found to be much higher than that of the normal pediatric population (4.2%). It is important to recognize this higher incidence of these abnormalities and to anticipate future associated symptoms and potential worsening listhesis that can clinically affect the lifestyles of these children and potentially require surgical treatment. The clinical significance of these findings will necessitate long-term follow-up.

Introduction: We report a case of cervical Pott's disease revealed by parapharyngeal abscess., Case Report: A seven-year-old boy was admitted with a three-week history of painful fluctuating left lateral cervical swelling, associated with night sweats. Examination found trismus, through which a lateral pharyngeal bulge could be observed. Incision and drainage of the abscess on a combined cervical-oropharyngeal approach was performed under general anesthesia, associated to non-specific antibiotherapy by parenteral route. Bacteriology was negative. After one week of antibiotherapy, fever persisted with onset of torticollis. A diagnosis of tuberculosis was considered. Tuberculin skin test was positive at 16.5 mm. A second sample by pharyngeal aspiration showed caseous pus with acid-fast bacilli. Cervical spine CT found a retrostyloid abscess with atlantoaxial lysis. Cervical Pott's disease complicated by Grisel syndrome was diagnosed. Antituberculosis therapy was initiated. Results at five months' follow-up were satisfactory., Discussion/conclusion: Parapharyngeal abscess with an etiology of Pott's disease is rare. Modern imaging is highly contributive to diagnosis and follow-up of lesion regression under treatment., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Spondylolysis is an osseous defect of the pars interarticularis, thought to be a developmental or acquired stress fracture secondary to chronic low-grade trauma. It is encountered most frequently in adolescents, most commonly involving the lower lumbar spine, with particularly high prevalence among athletes involved in certain sports or activities. Spondylolysis can be asymptomatic or can be a cause of spine instability, back pain, and radiculopathy. The biomechanics and pathophysiology of spondylolysis are complex and debated. Imaging is utilized to detect spondylolysis, distinguish acute and active lesions from chronic inactive non-union, help establish prognosis, guide treatment, and to assess bony healing. Radiography with satisfactory technical quality can often demonstrate a pars defect. Multislice CT with multiplanar reformats is the most accurate modality for detecting the bony defect and may also be used for assessment of osseous healing; however, as with radiographs, it is not sensitive for detection of the early edematous stress response without a fracture line and exposes the patient to ionizing radiation. Magnetic resonance (MR) imaging should be used as the primary investigation for adolescents with back pain and suspected stress reactions of the lumbar pars interarticularis. Several imaging pitfalls render MR imaging less sensitive than CT for directly visualizing the pars defects (regional degenerative changes and sclerosis). Nevertheless, the presence of bone marrow edema on fluid-sensitive images is an important early finding that may suggest stress response without a visible fracture line. Moreover, MR is the imaging modality of choice for identifying associated nerve root compression. Single-photon emission computed tomography (SPECT) use is limited by a high rate of false-positive and false-negative results and by considerable ionizing radiation exposure. In this article, we provide a review of the current concepts regarding spondylolysis, its epidemiology, pathogenesis, and general treatment guidelines, as well as a detailed review and discussion of the imaging principles for the diagnosis and follow-up of this condition.

Back pain in the young athlete is a common finding. There are many different problems that can cause back pain in active children. It is important for the treating physician to obtain a thorough history and physical examination to help in establishing the underlying cause for the discomfort. Appropriate imaging can be determined by these findings and further help to define the pathology. Depending upon the specific pathology, appropriate treatment may help the patient to safely return to the activities that they enjoy.

The incidence of isthmic spondylolysis is approximately 3% to 6% in the general population. Spondylolytic defects involving multiple vertebral levels, on the other hand, are extremely rare. Only a handful of reports have examined the outcomes of surgical treatment of multi-level spondylolysis. Here, we present one case of bilateral pars defects at L3, L4, and L5. The patient, a 46-year-old female, presented with lower back pain radiating into the left lower extremity. Radiographs and CT scans of the lumbar spine revealed bilateral pars defects at L3-L5. The patient underwent lumbar discectomy and interbody fusion of L4-S1 as well as direct repair of the pars defect at L3. There were no postoperative complications, and by seven months the patient had improved clinically. While previous reports describe the use of either direct repair or fusion in the treatment of spondylolysis, we are unaware of reports describing the use of both techniques at adjacent levels.

Lumbar spondylolysis is a stress fracture of the pars interarticularis. We have evaluated the site of origin of the fracture clinically and biomechanically. Ten adolescents with incomplete stress fractures of the pars (four bilateral) were included in our study. There were seven boys and three girls aged between 11 and 17 years. The site of the fracture was confirmed by axial and sagittal reconstructed CT. The maximum principal tensile stresses and their locations in the L5 pars during lumbar movement were calculated using a three-dimensional finite-element model of the L3-S1 segment. In all ten patients the fracture line was seen only at the caudal-ventral aspect of the pars and did not spread completely to the craniodorsal aspect. According to the finite-element analysis, the higher stresses were found at the caudal-ventral aspect in all loading modes. In extension, the stress was twofold higher in the ventral than in the dorsal aspect. Our radiological and biomechanical results were in agreement with our clinical observations.

Cervical spondylolysis is an uncommon disorder involving a cleft at the pars interarticularis. It is most often found at the C-6 level, and clinical presentations have included incidental radiographic findings, neck pain, and rarely neurological compromise. Although subaxial cervical spondylolysis has been described in 150 patients, defects at the C-2 pedicles are rare. The authors present 2 new cases of C-2 spondylolysis in athletically active young persons who did not demonstrate instability or neurological deficits, were able to remain active, and are being managed conservatively with serial examinations and imaging. They also discuss the results of 22 previously reported cases of C-2 spondylolysis. Based on the literature and their own experience, the authors conclude that most patients with C-2 spondylolysis remain neurologically intact, maintain stability despite the bony defect, and can be managed conservatively. Surgery is reserved for patients who demonstrate severe instability or spinal cord compromise due to stenosis.

A review of the current literature shows that there is a lack of consensus regarding the treatment of spondylolysis and spondylolisthesis in children and adolescents. Most of the views and recommendations provided in various reports are weakly supported by evidence. There is a limited amount of information about the natural history of the condition, making it difficult to compare the effectiveness of various conservative and operative treatments. This systematic review summarises the current knowledge on spondylolysis and spondylolisthesis and attempts to present a rational approach to the evaluation and management of this condition in children and adolescents.

Lower extremity stress fractures are relatively common among competitive athletes. Stress fractures of the upper extremity, however, are rare and most have been reported in the literature as case reports. We present a case of an adolescent baseball pitcher who had both proximal humeral and ulnar shaft stress fractures, as well as spondylolysis of the lumbar spine. This particular patient also had an underlying endocrine abnormality of secondary hyperparathyroidism with a deficiency in vitamin D. A bone mineral density panel demonstrated a high T score (+2.79 SD above the mean) and the patient's biologic bone age was noted to be 2 years ahead of his chronologic age. The patient was treated with a course of vitamin D and calcium supplementation. After treatment, both the vitamin D and parathyroid hormone returned to normal levels. The upper extremity stress fractures and spondylolysis were managed conservatively and he was able to return to full activity and baseball. For patients who present with multiple stress fractures not associated with consistent high levels of repeated stress, a bone mineral density panel should be considered. If vitamin D deficiency is present, a course of oral supplementation may be considered in the management. An endocrinology consult should also be considered in patients who present with multiple stress fractures. Conservative management of upper extremity stress fractures and spondylolysis was successful in returning this patient back to his previous activity level.

Study Design: Single case report., Objective: To report the observation of multiple lumbar pedicle fractures in a patient with osteopetrosis., Summary of Background Data: Osteopetrosis is characterized by osteoclast dysfunction, impaired bone resorption, and poor bone remodeling. As a result, the bone is brittle but hard and is referred to as "marble bone disease." Although long bone fractures are relatively common, fractures of the spine are rare. Spondylolysis has been reported in the cervical and lumbar spine, and pedicle fractures have been reported in the cervical spine. We report the case of a patient with autosomal dominant osteopetrosis with multiple lumbar pedicle fractures. To the best of our knowledge, there have been no previous reports of multiple lumbar pedicle fractures in osteopetrosis., Methods: A 73-year-old woman, with a known history of osteopetrosis, presented with acute nonradiating low back pain following a bout of coughing. The lower limb neurology and bladder and bowel function were normal. The imaging findings, clinical course, and treatment are discussed., Results: Initial computed tomography scans of the patient revealed the presence of multiple pedicle fractures with spondylolysis. The patient was advised bed rest for the first 3 days, and when the acute pain subsided, she was permitted to ambulate with a lumbosacral corset. The patient was asymptomatic for 8 months, when she was readmitted with another episode of acute low back pain. The CT scan revealed fresh fracture of the L4 pedicle, which was not seen on the previous scan. The pain settled down again with conservative measures., Conclusion: This case report discusses the rare occurrence of multiple lumbar pedicle fractures and pars interarticularis (spondylolysis) fractures in a patient with osteopetrosis.

An adolescent 15-yr-old male competitive gymnast presented to a university-based multidisciplinary spine institute with a persistent low-back pain for 18 mos. Although the results of x-rays were negative, his pain rendered him unable to compete in his sport any longer. A computed tomography scan was performed, which showed a bilateral pars fracture at L5, without spondylolisthesis. A nuclear medicine bone scan revealed negative findings, confirming chronic nonunion. The patient completed a 4-wk course of physical therapy 6 mos before our intervention, without any relief of pain or radiologic evidence of healing. The patient was treated with a bone stimulator for 4 hrs/day and was recommended to wear a warm-and-form-type brace. Isometric core trunk exercises were also initiated. Only after 6 wks of treatment, the subject showed clinical improvement at the follow-up visit. Computed tomography scan performed 12 wks after the initial scan showed complete union of the fracture correlating with clinical improvement. Two years later, the athlete remains completely pain-free, is training regularly, and is able to compete on a national and, possibly, international level.

Background Context: Cervical spondylolysis (CS) is a rare disorder involving a cleft in the articular mass, at the junction of the superior and inferior facet joints, and often a complex malformation of the posterior elements of the vertebra. The most commonly affected level is the sixth cervical vertebra. Most of the cases are adults. Its origin, mechanical or embryological, is controversial., Purpose: To report the case in a young boy and to outline the imaging findings related to the causal mechanism., Study Design: A case report., Patient Sample: A 7-year-old boy with CS of the sixth cervical vertebra discovered after a minimal trauma., Methods: Radiological observation and literature review., Results: A forward listhesis in extension is observed despite an intact disc on magnetic resonance imaging, expressing the loads applied to the dysplastic vertebra before the mechanical failure of the vertebral structures occurs., Conclusions: A mixed origin, both mechanical and congenital is suggested. It is proposed that the CS results from microimpacts because of the cervical spine biomechanics affecting a posterior arch prone to develop a cleft as a result of associated malformations.

Objective: Anterolateral partial oblique corpectomy (OC) aims to decompress the cervical spinal cord without subsequent fusion and saves the patient from graft-, instrument-, and fusion-related complications. Although it is a promising technique, there are few studies dealing with its efficacy and safety., Methods: In this prospective study, 40 consecutive patients underwent an OC (one to four levels from C3 to C7) for cervical spondylotic myelopathy; they ranged in age from 43 to 78 years (mean, 55 yr). The average follow-up period was 59 months (range, 24-98 mo). Clinical and radiological data were analyzed to assess the results and find possible factors related to outcomes., Results: Thirty-seven (92.5%) of the 40 patients improved by the 6-month follow-up examination according to the Japanese Orthopedic Association score. The improvement was the most prominent in lower extremity dysfunction. Recovery was positively correlated with the preoperative Japanese Orthopedic Association score (r = 0.37, P = 0.018). Permanent Horner's syndrome developed in four patients (10%). During the long-term follow-up period, neurological improvement was maintained and there were no signs of postoperative instability, posture change, or axial pain., Conclusion: OC for treating multilevel cervical spondylotic myelopathy achieved good results with a low morbidity rate. The results of the current study suggest that OC is a good alternative to conventional median corpectomy and fusion techniques in selected cases.

There is presented an experience of the examination of 517 cases including sportsmen and ballet dancers, 15-45 olds, suffering from low back pain syndrome. 265 patients were diagnosed with osteochondrosis, 105 cases--with spondylolis, 92--with facet syndrome, and 55 cases--with pelvic ligaments ligamentopathia. Based upon the analysis of the results of examination diagnostic algorithm and differential diagnostics of these diseases were developed. The use of the proposed algorithm in patients with dissimilar variants of low back pain syndrome showed its informational content. It permits to make a right diagnosis and apply an adequate therapeutic approach.

The last three decades have witnessed a tremendous increase in female sports participation at all levels. However, increased sports participation of female athletes has also increased the incidence of sport-related injuries, which can be either acute trauma or overuse injuries. Overuse injuries may be defined as an imbalance caused by overly intensive training and inadequate recovery, which subsequently leads to a breakdown in tissue reparative mechanisms. This article will review the most frequent overuse injuries in female athletes in the context of anatomical, physiological, and psychological differences between genders.

Summary of Background Data: Symptomatic spondylolysis resulting from a stress fracture of the pars interarticularis is a cause of low back pain in the juvenile and adolescent patient. Treatment is conservative in the majority of cases., Objective: To analyze the outcome of patients with symptomatic isthmic spondylolysis treated nonoperatively with a custom fit thoracolumbar orthosis and activity cessation for 3 months followed by an organized physical therapy program., Study Design: Retrospective case series., Patient Sample: Four hundred thirty-six juvenile and adolescent patients with spondylolysis., Outcome Measures: Pain improvement, hamstring flexibility, range of motion, resolution of back spasms, and return to previous activities., Methods: Retrospective review of 436 juvenile and adolescent patients with symptomatic spondylolysis confirmed by single-photon emission computed tomography or computed tomography. Clinical outcomes were assessed through patient history and physical examination., Results: Ninety-five percent of patients achieved excellent results according to a modified Odom's Criteria. The remaining 5% of patients achieved good results as they required occasional nonsteroidal anti-inflammatory drugs to relieve pain. Back spasms were resolved and hamstring tightness and range of motion returned to normal in all patients. All patients returned to their preinjury activity level. No patients went on to surgery., Conclusions: Symptomatic juvenile and adolescent patients with an isthmus spondylolysis may be effectively managed with a custom fit thoracolumbar orthosis brace and activity cessation for approximately 3 months followed by an organized physical therapy program.

Study Design: A case of acquired lumbar spondylolysis following lumbar disc arthroplasty L5-S1 in an 40-year-old woman and review of the literature., Objectives: To present and discuss a case of acquired lumbar spondylolysis after implantation of an artificial disc L5-S1 that may have impaired a good clinical result requiring additional posterior lumbar instrumentation and fusion in order to improve understanding of this condition and to propose an effective method of surgical management., Summary of Background Data: Lumbar disc arthroplasty is a possible surgical option for patients with degenerative disc disease. Acquired spondylolysis is a rare but known complication of spinal fusion but has never been described as a consequence of mobile disc arthroplasty. The authors present the first case in the literature who developed this complication., Methods: A 40-year-old woman with severe osteochondrosis L5-S1 and discogenic lumbar back pain underwent implantation of an artificial disc. Surgery and postoperative course were uneventful and the patient improved significantly as for back pain and mobility. Eighteen months after surgery, the patient was again admitted to our outpatient clinic for back pain that had slowly increased over time., Results: The radiologic workup showed a new spondylolysis L5 without a spondylolisthesis. Because of unsuccessful conservative treatment, the patient underwent posterior lumbar instrumentation and fusion L5-S1, leading to a significant pain reduction and a good clinical outcome., Conclusion: Spine surgeons should be aware of the possibility of lumbar disc arthroplasty to induce acquired spondylolysis impairing good clinical results.