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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

Abstract

Purpose

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).

Results

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.

Conclusions

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.

Keywords

Lumbar spondylolysis Adult Pars interarticularis Spina bifida occulta Pathophysiology 

Notes

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.

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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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