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Low-intensity pulsed ultrasound is effective for progressive-stage lumbar spondylolysis with MRI high-signal change

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Abstract

Purpose

This study aimed to investigate the treatment effects of low-intensity pulsed ultrasound (LIPUS) on progressive-stage spondylolysis. Spondylolysis is a stress fracture of the pars interarticularis. Based on the results of computed tomography, spondylolysis was classified into three categories: early, progressive, and terminal. Bone healing was prolonged or not obtained in progressive-stage spondylolysis. The progression of spondylolysis to nonunion has been associated with an increased incidence of spondylolisthesis. To prevent these clinical conditions, achieving bony healing of the spondylolysis site should be the goal of treatment.

Methods

15 consecutive pediatric patients with progressive-stage spondylolysis (defects) with MRI high-signal change were analyzed. Nine patients were treated conservative treatment including avoidance of any sport activity and the use of a brace during treatment (conventional). Six patients were treated using LIPUS everyday during treatment in addition to conservative treatment. Approximately every 1.5 months, bone healing was evaluated via CT. Cases that retained defects after 4.5 months were defined as nonunion.

Results

Two patients dropped out during the study period. A total of 13 patients (mean 14.6 ± 2.5 years) from the database met with 19 interarticularis defects. The bone union rate in LIPUS group was significantly higher than that in conventional group (66.7 vs. 10.0%, p = 0.020). The treatment period to bone union was 3.8 months and 2.7 ± 0.3 months in conventional and LIPUS groups.

Conclusions

This study revealed that LIPUS treatment might be effective for bone union in patients with progressive-stage spondylolysis with MRI high-signal change.

Level of evidence

4.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka-ken, 431-3192, Japan

    Hideyuki Arima, Yuki Mihara & Yukihiro Matsuyama

  2. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA

    Hideyuki Arima

  3. Department of Orthopaedic Surgery, Kikugawa General Hospital, 1632, Higashiyokochi, Kikugawa, Shizuoka-ken, 439-0022, Japan

    Yoshiji Suzuki & Hideyuki Murata

  4. Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka-ken, 431-3192, Japan

    Daisuke Togawa

Authors
  1. Hideyuki Arima
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  2. Yoshiji Suzuki
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  3. Daisuke Togawa
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Correspondence to Hideyuki Arima.

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Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Funding

HA and YS has nothing to disclose. DT has a donated fund laboratory by Medtronic Sofamor Danek, Inc (Memphis, TN, USA), Japan Medical Dynamic Marketing Inc. (Tokyo, Japan), and Meitoku Medical Institute Jyuzen Memorial Hospital (Hamamatsu, Japan). YM, HM, and YM have nothing to disclose.

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Arima, H., Suzuki, Y., Togawa, D. et al. Low-intensity pulsed ultrasound is effective for progressive-stage lumbar spondylolysis with MRI high-signal change. Eur Spine J 26, 3122–3128 (2017). https://doi.org/10.1007/s00586-017-5081-z

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  • DOI: https://doi.org/10.1007/s00586-017-5081-z

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