Surgical treatment of four segment lumbar spondylolysis:A case report

Four-level lumbar spondylolysis is extremely rare.So far,only 1 case has been reported in the literature.CASE SUMMARY A 19-year-old man presented with severe back pain irresponsive to conservative therapies for 2 years.Lumbar radiographs and two-dimensional computed tomography scan showed four segment lumbar spondylolysis on both sides of L2-L5.Lumbar magnetic resonance imaging showed normal signal in all lumbar discs.Because daily activities were severely limited,surgery was recommended for the case.The patient underwent four-level bilateral isthmic repair at L2-L5.During surgery,L2-L5 isthmi were curetted bilaterally,freshened,and then grafted with autologous iliac bone that was bridged and compressed with a pedicular screw connected to a sub-laminar hook by a short rod.The symptoms of back pain almost disappeared.He has been followed-up for 96 mo,and his symptoms have never recurred.Fusion was found in all repaired isthmi 14 mo after surgery according to evaluation of lumbar radiography and computed tomography scan.CONCLUSION We report here 1 case of four-level lumbar spondylolysis that was treated successfully with direct isthmic repair.

Combining Posterolateral Lumbar Fusion and Posterior Lumber Interbody Fusion Surgery for Treating Three-Level Lumber Spondylolysis and Single-Level Spondylolisthesis: Case Report

Lumbar spondylolysis is a relatively common condition that can cause a variety of clinical manifestations related to the lumbar spine. However, multi-level lumbar spondylolysis is rare and accounts for less than 6% of lumbar spondylolysis. We report a case of three-level lumbar spondylolysis with single-level spondylolisthesis. A 47-year-old woman presented to us with low back pain for 9 years that progressively worsened and the pain was exacerbated with standing and walking. She was diagnosed with three-level lumbar spondylolysis at L3-5 and spondylolisthesis at L4. We performed posterolateral lumber fusion (PLF) and posterior lumbar interbody fusion (PLIF) surgery for her. During the same period, pain recovery and fusion rate of the patient were evaluated after surgery. The results were favorable and proved the efficacy of combining PLF and PLIF technique for treatment for three-level lumbar spondylolysis and single-level spondylolisthesis.

Return to sports activity by athletes after treatment of spondylolysis

AIM:To clarify the efficacy of conservative and surgical treatment of spondylolysis in athletes.METHODS:PubMed was used to perform a search of the literature for studies published during the period from 1990 to 2009 that reported data on the outcome of conservative or surgical treatment of spondylolysis in athletes.The articles were examined for data on the percentage of athletes who returned to sports activities and the interval between the start of treatment and their return.RESULTS:Five studies were identified.Two studies were concerned with conservative treatment and the other three with surgical treatment(wire fixation or screw fixation with bone graft).The percentages of athletes who returned to sports activities ranged from 80.0%to 89.3%and from 81.9%to 100%,respectively,and the intervals until their return ranged from 5.4 to 5.5 mo and from 7 to 12 mo,respectively.CONCLUSION:The percentages of athletes who returned to sports activities after conservative and surgical treatment appeared to be satisfactory,but the

Application of a new anatomic hook-rod-pedicle screw system in young patients with lumbar spondylolysis:A pilot study

BACKGROUND The pedicle screw-laminar hook system has strong fixation and is conducive to bone graft fusion for lumbar spondylolysis.However,the current pedicle screwlaminar hook fixation system is not specifically designed for lumbar spondylolysis.AIM To investigate the clinical effects of a new anatomical hook-rod-pedicle screw system in the treatment of lumbar spondylolysis in young adults.METHODS We designed a new anatomic hook-rod-pedicle screw system for young patients with lumbar spondylolysis.The isthmus and the corresponding pedicle screw entry point were exposed through the intermuscular approach.Autogenous iliac bone graft was obtained to bridge the isthmus defect,and then the anatomic hook-rod-pedicle screw system was used to fix the isthmus in 15 young patients.RESULTS At 24 mo follow-up,the visual analogue scale score of low back pain decreased from 6.73±0.88 to 0.73±0.59,and the Oswestry disability index score decreased from 58.20±8.99 to 7.87±4.97.Computed tomography showed bilateral isthmic bone healing in 14 cases and unilateral isthmic bone healing in 1 case.Magnetic resonance imaging showed that the lumbar disc signal of diseased segment and adjacent segments had no change compared with that before surgery.The pain visual analogue scale score of the donor site was 0.20±0.41 at the last follow-up.According to the Modified Macnab score,the excellent and good rate was 100%.CONCLUSION The application of this new anatomical hook-rod-pedicle screw system to treat young patients with lumbar spondylolysis has the advantages of less trauma,a simple operation and satisfactory clinical effects.

Vibration Signal Analysis for Detecting Early-Stage Lumbar Spondylolysis Using Synthetic Bone

Bone fractures can be detected by analyzing vibration signals following bone stimulation. This method can also be applied to detect stress fractures, such as spondylolysis. The aim of this study was to investigate whether vibration signal analysis can be used to detect lumbar spondylolysis in synthetic bone. Four synthetic spondylolysis models of the fifth lumbar vertebra (Sawbones, product No. SAW1352-10: Malm&#246;, Sweden) were prepared, with the following conditions: intact, unilateral defect, and bilateral defect. Unilateral defects were created by making an incision of either half the diameter (50% incision) or the entire diameter (100% incision) in length through the pars interarticularis or pedicle. Bilateral defects were created by making an additional incision of half the diameter in length on the opposite side of the defected pars interarticularis or pedicle (50% + 100% incision). Hammering was performed five times on each spinous process of the fixed synthetic bones and vibration signals were measured using an accelerometer attached to the contralateral side of the hammer. Signals were analyzed using fast Fourier transform. The parameters analyzed included the mean power frequency, first power minimum frequency (the minimum value between the first and second peaks), spectral areas of low and high frequency bands, and the relative ratio between the spectral areas of low and high frequency bands. The relative ratio was significantly lower in the 50%, 100%, and 50% + 100% incision conditions compared to the intact condition (p < 0.01), suggesting the potential utility of vibration signal analysis in diagnosing lumbar spondylolysis.

Study on clinical effects of pedicle screw combined with immobilized implantation bone by wirerope and hallow compression screw immobilization in treating spondylolysis of lumbar vertebra of multiple segments of adults

Objective:To observe clinical effects of pedicle screw fixation combined with cable wires and bone graft and cannulated compression screws on adult multi-segment lumbar spondylolysis.Methods:70 cases of patients with multi-segment lumbar spondylolysis were selected in our hospital.According to different surgical schemes,these patients were divided into the observation group(35 cases)and the control group(35 cases).The observation group received pedicle screw fixation combined with cable wires and bone graft and the control group received cannulated compression screw fixation.Macnab criteria were adopted to implement a therapeutic evaluation of two groups of patients to make an observation and comparison of the excellent and good rate of surgery and a series of indicators including perioperative clinical effects,intraoperative blood loss,duration of surgery,hospital length of stay(HLOS),visual analogue scale(VAS),Oswestry disability index and Japanese Orthopaedic Association(JOA)score.Results:The excellent and good rate of the observation group was 97.14%,and that of the control group was 82.86%,the difference between two groups was statistically significant(χ^(2)=6.248,p=0.012).The differences in intraoperative blood loss,duration of surgery and HLOS between two groups were statistically significant(t=-4.55,t=-4.55,t=-4.55;p<0.05).Oswestry index,VAS score and JOA score of the observation group were(2.4±0.9),(28.5±6.4)and(27.1±3.1)respectively,and these of the control group were(3.5±1.2),(37.1±7.8)and(21.3±2.7)respectively,the differences between two groups were statistically significant(t=4.338,t=5.043,t=8.347,p<0.05).Conclusions:Pedicle screw combined with immobilized implantation bone by wirerope has an excellent clinical effect on the treatment of adult multi-segment lumbar spondylolysis,and it has a series of advantages such as fast postoperative recovery,small surgical trauma and so on.In addition,this technique can also restore the stability of spinal segments and relieve pains to a greater degree.

Differences of Sagittal Lumbosacral Parameters between Patients with Lumbar Spondylolysis and Normal Adults

Background： Recent studies have suggested an association between elevated pelvic incidence （PI） and the development of lumbar spondylolysis. However, there is still lack of investigation for Hart Chinese people concerning the normal range ofspinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population. Methods： A total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force （Beijing, China） were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A： 36 patients with simple lumbar spondylolysis, and Subgroup B： 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis （slip percentage 〈30%）. Altogether 207 healthy adults were chosen as the control group. All patients and the control group took lumbosacral lateral radiographs. Seven sagittal lumbosacral parameters, including PI, pelvic tilt （PT）, sacral slope （SS）, lumbar lordosis （LL）, L5 incidence, L5 slope, and sacral table angle （STA）, were measured in the lateral radiographs. All the parameters aforementioned were compared between the two subgroups and between the spondylolysis group and the control group with independent-sample t-test. Results： There were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher （P 〈 0.05） in the spondylolysis group than those in the control group, but STA was lower （P 〈 0.001 ） in the spondylolysis group. Conclusions： Current study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population.

Incomplete spondylolysis of the first sacrum： a case report

Spondylolysis is generally attributed to stress fracture, due to movement of the affected vertebrae relative to the vertebra below and is most common in lower lumbar vertebrae.Since S1 and S2 are fused, spondylolysis of S1 due to stress fracture would unlikely to occur. Although there have been some reports of S1 spondylolysis in ancient Alaskan and Canadian lnuit skeletons, no clinical S1 spondylolysis case due to stress fracture has been reported until now. A 17-year-old, female gymnast with incomplete spondylolysis of S1 is presented here.

Rare bilateral C3 cervical spondylolysis: Report of four cases and a literature review

Objective: To review and discuss the etiology, diagnosis and treatment C3 of bilateral cervical spondylolysis. Methods: This was a retrospective review of the clinical features, imaginge findings,and treatment of 4 cases of bilateral C3 cervical spondylolysis, with a review of the literature. Results: A 21‐year‐old woman, a 26‐year‐old man, a 14‐year‐old boy, and a 46‐year‐old man were diagnosed with bilateral C3 cervical spondylolysis. The patients had characteristic bilateral clefts between the articular pillar and the facets of C3, as well as spina bifida on CT. Although spondylolisthesis was not observed, spinal cord compression was definitive. All patients underwent posterior decompression with satisfactory results. Conclusions: C3 cervical spondylolysis is rare condition. The cause is most likely congenital. Diagnosis is dependent on characteristic radiological features. Surgical treatment is the first choice.

Application of 3D printing technique in pedicle screw placement for the lumbar isthmic spondylolisthesis

Objective:To investigate the application value of 3D printing technique in the operation of the lumbar isthmic spondylolisthesis.Methods Totally 48 patients with lumbar isthmic spondylolisthesis treated in our department from January 2015 to April 2017 were selected in the research plan.According to the random digital table method,they were divided into the observation group and the control group,with 25 cases in the observation group and 23 cases in control group.All patients were treated with transforaminal lumbar interbody fusion(TLIF).The control group made the observation group made the operation plan with 3D printing technology,and the operation plan according to the 3D CT reconstruction image.The clinical and imaging results were compared between the two groups、including operation time、intraoperative blood loss and X-ray exposure、complications、preoperative and postoperative ODI and JOA score.Results The accuracy of the screw placement in the observation group was 95.33%,which was significantly higher than those of 84.06%in the control group,the differences were statistically significant(P<0.05).Operation time and X-ray exposure and intraoperative blood loss in observation group were less than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences spondylolisthesis reduction degree、ODI and JOA scores at postoperative different point between groups(P>0.05).Conclusions 3D printing technology is helpful to the development of the lumbar isthmic spondylolisthesis surgical plan,with the advantages of shortening the operation time and X-ray exposure,reducing the blood loss,improving the accuracy of the screw placement.

Comparison of Two Radiographic Lumbar Spine Screening Protocols for the Detection of Abnormalities in Special Forces Candidates

Background: Medical screening for Special Forces (SF) has significant implications on operational competency of the soldiers. Two lumbar spine defects, spondylolysis and spondylolisthesis, are currently disqualifying from joining the SF in the Israeli Defense Force. Purpose: To evaluate the yield of four lumbar x-ray compared with two lumbar x-ray for the diagnosis of spondylolysis and spondylolisthesis. Design: Retrospective comparison of the diagnostic yield of the two modalities. Patient sample: Special forces unit candidates undergoing routine x-ray for the diagnosis of spinal defects. Outcome measures: The rate of diagnosis of spondylolysis and spondylolisthesis between the two groups. Methods: We retrospectively compared two lumbar spine radiographic screening protocols regarding the rate of diagnosis for disqualifying spinal defects in asymptomatic candidates for SF. All radiographs were obtained as part of a routine medical evaluation for SF. Results: 1026 candidates were examined with two lumbar spine radiographs (Anteroposterior (AP) and lateral). 338 candidates were examined with four lumbar radiographs (AP, lateral and oblique radiographs). Spondylolysis and spondylolisthesis were diagnosed at a significantly higher rate in the four-radiograph group than in the two-radiograph group (2.66%, 1.77% vs. 1.26%, 0.39% respectively, P = 0.003). Conclusions: Adding two oblique radiographs to the screening process of elite units candidates significantly increases the rate of diagnosis of spondylolysis and spondylolisthesis.

rhBMP in lumber fusion for lumbar spondylolisthesis: A systematic review and meta-analysis

Purpose: To compare the efficacy and safety of recombinant human bone morphogenetic protein (rhBMP) and iliac crest autograft in the fusion treatment of lumbar spondylolisthesis. Methods: The studies using randomized con trolled trials to compare the rhBMP with iliac crest autograft in the treatment of lumbar spondylolisthesis were retrieved from Embase, Pubmed, ProQuest dissertations & theses (PQDT), China national knowledge infrastructure (CNKI), Chinese Biomedical Database, Wanfang Data, Cochrane Library (from March 1998 to March 2018). Postoperative fusion rate, clinical success rate, postoperative intervertebral height, complications, operation time, blood loss and duration of hospitalization were chosen as the outcome indicators. Methodological quality of the trials was critically assessed, and releva nt data were extracted. Statistical software Revman 5.3 was used for dataanalysis. Results: Eleven articles were included in the meta-analysis. The results showed that, comparing the efficacy of rhBMP with iliac crest autograft, statistical significance was found in the 24-month fusion rate post operation [95% CI (1.38, 24.70), p = 0.02] and operation time [95% CI (-14.22,-2.08), p = 0.008]. There is not sufficient evidence for statistical differences in the remaining indicators. Conclusion: The current literature shows rhBMP is a safe and effective grafting material in the treatment of lumbar spondylolisthesis. Further evidenee is dependent on the emergence of more randomized controlled trials with higher quality and larger sample sizes in the future.