Clinical features of patients with pars defects identified in adulthood

  • Toshinori SakaiEmail author
  • Yuichiro Goda
  • Fumitake Tezuka
  • Mitsunobu Abe
  • Kazuta Yamashita
  • Yoichiro Takata
  • Kosaku Higashino
  • Akihiro Nagamachi
  • Koichi Sairyo
Original Article • SPINE - SPONDYLOLYSIS



Lumbar spondylolysis is considered a stress fracture of the pars interarticularis that occurs during growth. However, it is sometimes insidious and identified in adults as pseudoarthrosis, the terminal-stage of spondylolysis. The purpose of this study was to identify the clinical features of patients with terminal-stage spondylolysis that first manifested during adulthood.

Patients and methods

Thirty-six patients (21 men, 15 women; mean age 55.8 years; age range 25–77 years) with low back pain (LBP) were studied. In all patients, lumbar spondylolysis had not been diagnosed until the first visit to our hospital. Patient data collected were history of athletic activity and LBP during their growth period and radiological findings, such as spinal level, displacement, and spina bifida occulta (SBO).


Among the 36 patients, including a patient with multi-level spondylolysis (L4 and L5), a total of 37 vertebrae with terminal-stage spondylolysis were identified. Twenty-three (89.2 %) of the 37 vertebrae had L5 spondylolysis. Sixteen patients (44.4 %) had no history of athletic activity, 26 (72.2 %) had no experience of LBP during their growth period, and 14 (38.9 %) had neither. Twenty of the 37 vertebrae (70.4 %) involved displacement (grade 1 = 14; grade 2 = 6). In nine patients (25.0 %; eight men, one woman), SBO of the sacrum was accompanied by L5 spondylolysis.


Approximately 90 % of patients with terminal-stage spondylolysis that was first diagnosed in adulthood involved the L5. Also, about 40 % had no history of athletic activity or experience of LBP during their growth period. In addition, only some patients with L5 spondylolysis had SBO, and all but one of these patients was male. This suggests that male patients with L5 spondylolysis may have some congenital predisposition.


Lumbar spondylolysis Adult Pars interarticularis Spina bifida occulta Pathophysiology 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest that could bias the nature of this report.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Wiltse LL, Widell EH Jr, Jackson DW (1975) Fatigue fracture: the basic lesion in isthmic spondylolisthesis. J Bone Joint Surg Am 57:17–22PubMedGoogle Scholar
  2. 2.
    Wiltse LL (1957) Etiology of spondylolisthesis. Clin Orthop Relat Res 10:48–59Google Scholar
  3. 3.
    Sakai T, Yamada H, Nakamura T et al (2006) Lumbar spinal disorders in patients with athetoid cerebral palsy: a clinical and biomechanical study. Spine (Phila Pa 1976) 31:E66–E70CrossRefGoogle Scholar
  4. 4.
    Terai T, Sairyo K, Goel VK et al (2010) Spondylolysis originates in the ventral aspect of the pars interarticularis: a clinical and biomechanical study. J Bone Joint Surg Br 92:1123–1127CrossRefPubMedGoogle Scholar
  5. 5.
    Sairyo K, Sakai T, Yasui N et al (2012) Conservative treatment for pediatric lumbar spondylolysis to achieve bone healing using a hard brace: what type and how long? Clinical article. J Neurosurg Spine 16:610–614CrossRefPubMedGoogle Scholar
  6. 6.
    Sairyo K, Sakai T, Yasui N (2009) Conservative treatment of lumbar spondylolysis in childhood and adolescence: the radiological signs which predict healing. J Bone Joint Surg Br 91:206–209CrossRefPubMedGoogle Scholar
  7. 7.
    Sakai T, Sairyo K, Suzue N et al (2010) Incidence and etiology of lumbar spondylolysis: review of the literature. J Orthop Sci 15:281–288CrossRefPubMedGoogle Scholar
  8. 8.
    Yamada A, Sairyo K, Shibuya I et al (2013) Lumbar spondylolysis in juveniles from the same family: a report of three cases and a review of the literature. Case Rep Orthop 2013:272514. doi: 10.1155/2013/272514 PubMedPubMedCentralGoogle Scholar
  9. 9.
    Sakai T, Goda Y, Tezuka F et al (2015) Characteristics of lumbar spondylolysis in elementary school age children. Eur Spine J (Epub ahead of print) Google Scholar
  10. 10.
    Sakai T, Sairyo K, Takao S et al (2009) Incidence of lumbar spondylolysis in the general population in Japan based on multidetector computed tomography scans from two thousand subjects. Spine (Phila Pa 1976) 34:2346–2350CrossRefGoogle Scholar
  11. 11.
    Cai T, Yang L, Cai W et al (2015) Dysplastic spondylolysis is caused by mutations in the diastrophic dysplasia sulfate transporter gene. Proc Natl Acad Sci USA 112(26):8064–8069Google Scholar
  12. 12.
    Meyerding HW (1932) Spondylolisthesis. Surg Gynecol Obstet 54:371–377Google Scholar
  13. 13.
    Libson E, Bloom RA, Dinari G (1982) Symptomatic and asymptomatic spondylolysis and spondylolisthesis in young adults. Int Orthop 6:259–261PubMedGoogle Scholar
  14. 14.
    Fredrickson BE, Baker D, McHolick WJ et al (1984) The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 66:699–707PubMedGoogle Scholar
  15. 15.
    Wynne-Davies R, Scott JH (1979) Inheritance and spondylolisthesis: a radiographic family survey. J Bone Joint Surg Br 61:301–305PubMedGoogle Scholar
  16. 16.
    Saraste H (1993) Spondylolysis and spondylolisthesis. Acta Orthop Scand 251:84–86CrossRefGoogle Scholar
  17. 17.
    Shahriaree H, Sajadi K, Rooholamini SA (1979) A family with spondylolisthesis. J Bone Joint Surg Am 61:1256–1258PubMedGoogle Scholar
  18. 18.
    Albanese M, Pizzutillo PD (1982) Family study of spondylolysis and spondylolisthesis. J Pediatr Orthop 2:496–499CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2015

Authors and Affiliations

  • Toshinori Sakai
    • 1
    Email author
  • Yuichiro Goda
    • 1
  • Fumitake Tezuka
    • 1
  • Mitsunobu Abe
    • 1
  • Kazuta Yamashita
    • 1
  • Yoichiro Takata
    • 1
  • Kosaku Higashino
    • 1
  • Akihiro Nagamachi
    • 1
  • Koichi Sairyo
    • 1
  1. 1.Department of Orthopaedic Surgery, Institute of Health BiosciencesTokushima UniversityTokushimaJapan

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