Asian Spine Journal

Korean Society of Spine Surgery (대한척추외과학회)
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Segmental Lordosis of the Spondylolytic Vertebrae in Adolescent Lumbar Spondylolysis: Differences between Bilateral L5 and L4 Spondylolysis

  • Received : 2017.12.21
  • Accepted : 2018.04.17
  • Published : 2018.12.31
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Abstract

Study Design: Retrospective study. Purpose: This study aimed to investigate whether segmental lumbar hyperlordosis of the affected vertebra in patients with spondylolysis occurs only at L5 or also occurs at L4. Overview of Literature: To the best of our knowledge, increase in segmental lordosis of the spondylolytic vertebrae has only been investigated in bilateral L5 spondylolysis; it has not been examined at different levels of bilateral spondylolysis. According to the characteristics of segmental lordosis in bilateral L5 spondylolysis, patients with bilateral L4 spondylolysis may also have increased segmental lordosis of the L4 vertebra. Methods: Patients with bilateral spondylolysis of the L5 or L4 vertebra in 2013-2015 were retrospectively identified from the hospital database. Standing lateral lumbar radiographs were assessed for the angle of segmental lordosis of the L5 and L4 vertebra, sacral slope, and lumbar lordosis. The differences in segmental lordosis of the L5 and L4 vertebra, sacral slope, and lumbar lordosis were determined using non-paired Student t-test. Results: Overall, 15 cases of bilateral L4 spondylolysis and 41 cases of bilateral L5 spondylolysis satisfied the inclusion and exclusion criteria. Lordosis of the L4 vertebra was significantly greater in the bilateral L4 spondylolysis group ($24.2^{\circ}{\pm}7.0^{\circ}$) than that in the L5 spondylolysis group ($20.3^{\circ}{\pm}6.1^{\circ}$, p=0.047). Lordosis of the L5 vertebra was significantly lower in the L4 spondylolysis group ($27.7^{\circ}{\pm}8.2^{\circ}$) than that in the L5 spondylolysis group ($32.5^{\circ}{\pm}7.3^{\circ}$, p=0.040). The sacral slope and lumbar lordosis did not significantly differ between the groups. Conclusions: Adolescent patients with bilateral spondylolysis have segmental hyperlordosis of the affected vertebra not only at the L5 level but also at the L4 level.

Keywords

References

  1. Wiltse LL, Newman PH, Macnab I. Classification of spondylolisis and spondylolisthesis. Clin Orthop Relat Res 1976;117:23-9.
  2. Sakai T, Sairyo K, Takao S, Nishitani H, Yasui N. Incidence of lumbar spondylolysis in the general population in Japan based on multidetector computed tomography scans from two thousand subjects. Spine (Phila Pa 1976) 2009;34:2346-50. https://doi.org/10.1097/BRS.0b013e3181b4abbe
  3. Belfi LM, Ortiz AO, Katz DS. Computed tomography evaluation of spondylolysis and spondylolisthesis in asymptomatic patients. Spine (Phila Pa 1976) 2006;31:E907-10. https://doi.org/10.1097/01.brs.0000245947.31473.0a
  4. Goda Y, Sakai T, Sakamaki T, Takata Y, Higashino K, Sairyo K. Analysis of MRI signal changes in the adjacent pedicle of adolescent patients with fresh lumbar spondylolysis. Eur Spine J 2014;23:1892-5. https://doi.org/10.1007/s00586-013-3109-6
  5. Roussouly P, Gollogly S, Berthonnaud E, Labelle H, Weidenbaum M. Sagittal alignment of the spine and pelvis in the presence of L5-s1 isthmic lysis and low-grade spondylolisthesis. Spine (Phila Pa 1976) 2006;31:2484-90. https://doi.org/10.1097/01.brs.0000239155.37261.69
  6. Cyron BM, Hutton WC, Troup JD. Spondylolytic fractures. J Bone Joint Surg Br 1976;58-B:462-6. https://doi.org/10.1302/0301-620X.58B4.1018032
  7. Sairyo K, Katoh S, Komatsubara S, et al. Spondylolysis fracture angle in children and adolescents on CT indicates the facture producing force vector: a biomechanical rationale. Internet J Spine Surg [Internet]. 2004 [cited 2016 Mar 1];1:[about 9 screens]. Available from: http://ispub.com/IJSS/1/2/3373.
  8. Farfan HF, Osteria V, Lamy C. The mechanical etiology of spondylolysis and spondylolisthesis. Clin Orthop Relat Res 1976;117:40-55.
  9. Troup JD. Mechanical factors in spondylolisthesis and spondylolysis. Clin Orthop Relat Res 1976;117:59-67.
  10. Bugg WG, Lewis M, Juette A, Cahir JG, Toms AP. Lumbar lordosis and pars interarticularis fractures: a case-control study. Skeletal Radiol 2012;41:817-22. https://doi.org/10.1007/s00256-011-1296-y
  11. Chung SB, Lee S, Kim H, Lee SH, Kim ES, Eoh W. Significance of interfacet distance, facet joint orientation, and lumbar lordosis in spondylolysis. Clin Anat 2012;25:391-7. https://doi.org/10.1002/ca.21222
  12. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 2005;30:346-53. https://doi.org/10.1097/01.brs.0000152379.54463.65
  13. Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 2005;87:260-7. https://doi.org/10.2106/JBJS.D.02043
  14. Sairyo K, Sakai T, Yasui N. Conservative treatment of lumbar spondylolysis in childhood and adolescence: the radiological signs which predict healing. J Bone Joint Surg Br 2009;91:206-9.
  15. El Rassi G, Takemitsu M, Woratanarat P, Shah SA. Lumbar spondylolysis in pediatric and adolescent soccer players. Am J Sports Med 2005;33:1688-93. https://doi.org/10.1177/0363546505275645
  16. Sairyo K, Sakai T, Yasui N, Dezawa A. Conservative treatment for pediatric lumbar spondylolysis to achieve bone healing using a hard brace: what type and how long?: clinical article. J Neurosurg Spine 2012;16:610-4. https://doi.org/10.3171/2012.2.SPINE10914