1/35. Imaging features of cervical spondylolysis--with emphasis on MR appearances.AIM: To describe the imaging features of cervical spondylolysis, with emphasis on magnetic resonance imaging (MRI) appearances. MATERIALS AND methods: The clinical and imaging features (plain radiographic, CT and MRI) of three patients with cervical spondylolysis were reviewed. RESULTS AND CONCLUSIONS: Three cases of C6 cervical spondylolysis have been described and the world literature reviewed. The plain radiographic features in two cases with bilateral defects showed spondylolisthesis and abnormalities of the pars and adjacent facet joints. CT demonstrated well corticated defects and associated spina bifida occulta in all cases. The defects were seen in only one case on MRI but in all cases, absence of the spinous process of C6 was noted on sagittal sequences due to the spina bifida occulta. Cervical spondylolysis is an uncommon condition that must be distinguished from an acute fracture and diagnosed radiologically to prevent mismanagement. Although the defect may be difficult to identify on MRI, absence of the spinous process on sagittal sequences should raise the suspicion of the abnormality.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/35. Iatrogenic spondylolysis leading to contralateral pedicular stress fracture and unstable spondylolisthesis: a case report.STUDY DESIGN: A case report of iatrogenic spondylolysis as a complication of microdiscectomy leading to contralateral pedicular stress fracture and unstable spondylolisthesis. OBJECTIVE: To improve understanding of this condition by presenting a case history and roentgenographic findings of a patient that differ from those already reported and to propose an effective method of surgical management. methods: A 67-year-old woman with no history of spondylolysis or spondylolisthesis underwent an L4-L5 microdiscectomy for a left herniated nucleus pulposus 1 year before the current consultation. For the preceding 8 months, she had been experiencing low back and bilateral leg pain. Imaging studies revealed a left L4 spondylolytic defect and a right L4 pedicular stress fracture with an unstable Grade I spondylolisthesis. RESULTS: The patient was treated with posterior spinal fusion, which resulted in complete resolution of her clinical and neurologic symptoms. CONCLUSIONS: Iatrogenic spondylolysis after microdiscectomy is an uncommon entity. However, it can lead to contralateral pedicular stress fracture and spondylolisthesis, and thus can be a source of persistent back pain after disc surgery. Surgeons caring for these patients should be aware of this potential complication.- - - - - - - - - - ranking = 7keywords = fracture (Clic here for more details about this article) |
3/35. Cervical spondylolysis in children: is it posttraumatic?Cervical spondylolysis is a rare defect of unknown etiology. Five cases of cervical spondylolysis as well as two cases of fractures of the pedicles of C2 in infants are presented. Comparison of the cases suggests that a fracture at birth or in infancy may be the cause of some cases of cervical spondylolysis.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
4/35. Pedicular stress fracture in lumbar spine.The purpose of this article is to report two cases of pedicular stress fracture of the lumbar spine, which is an uncommon cause of low back and leg pain. The relevant literature is reviewed and features of the cases that differ from those already reported are highlighted. One of our cases of pediculolysis is the first in the literature for that is caused by rotational instability induced by laminectomy. The remodeling of the fractured pedicle was striking when compared with its normal counterpart. To the authors' knowledge, this is the first report of a pediculolysis with T2-weighted imaging findings. In addition, we report the computed tomographic (CT) and magnetic resonance (MR) imaging findings of a healed pediculolysis that has not been reported previously.- - - - - - - - - - ranking = 6keywords = fracture (Clic here for more details about this article) |
5/35. pycnodysostosis associated with spondylolysis.We report 23 years of observation of a patient with pycnodysostosis associated with progressive spondylolysis. There have been very few papers describing the development of spondylolysis associated with pycnodysostosis as confirmed by serial X-ray examinations. The diagnosis was made by the patient's typical bird-like face, plain radiological findings, and repeated tibial fractures. At the age of 8 years, spondylolysis of L4 was observed. The spondylolysis had increased in number to 4 by the age of 24 years, that is, L2 through L5.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
6/35. Acute progression of spondylolysis to isthmic spondylolisthesis in an adult.STUDY DESIGN: Acute progression of spondylolysis to spondylolisthesis in an adult without degenerative disc disease at the slip level is reported. OBJECTIVE: To document a case of adult-onset progression of isthmic spondylolisthesis, in which the disc space height at the slip level was normal. There were no known risk factors for progression, and the olisthesis occurred acutely after minimal trauma. SUMMARY OF BACKGROUND DATA: adult progression of spondylolysis to spondylolisthesis is reported infrequently because the highest risk for slip progression is before skeletal maturity. Previous reports documenting progressive slips in adults have uniformly related the olisthesis to progressive disc collapse and subluxation below the pars defect. methods: A 39-year-old woman was evaluated for a primary complaint of back and bilateral leg pain. Standing radiographs of her lumbar spine showed an L4-L5 and L5-S1 spondylolysis without spondylolisthesis. She had severe degenerative disc changes at L5-S1. The disc space height was normal at L4-L5. Two years later she was essentially immobilized by back pain after minimal trauma. Standing radiographs demonstrated a new Grade 2 L4-L5 isthmic spondylolisthesis. As demonstrated by magnetic resonance imaging, spontaneous reduction of the olisthesis has occurred with normal disc space height maintained. RESULTS: An L4-S1 anterior lumbar interbody fusion and posterior decompression and spinal fusion with instrumentation were performed without complication. At this writing, the patient has returned to work and is doing well 1 year after surgery. CONCLUSIONS: This case is important because it illustrates the potential for acute progression of spondylolisthesis with minimal trauma. A patient with known spondylolysis who sustains acute severe exacerbation of his or her back pain should have repeat standing radiographs.- - - - - - - - - - ranking = 0.021749237031951keywords = compression (Clic here for more details about this article) |
7/35. Congenital spondylolysis of the axis with associated myelopathy. Case report.Cervical spondylolysis is a rare clinical entity and occurs predominantly at the C-6 level. The authors describe a patient with congenital spondylolysis of the axis that caused myelopathy. The patient was a 57-year-old woman with long-standing gait disturbance. Plain cervical radiography revealed a radiolucent defect across the pedicle of the axis. magnetic resonance imaging of the cervical spine in the neutral, flexion, and extension neck positions as well as a computerized tomography myelography in the neutral neck position failed to demonstrate any spinal cord compression. When she rotated her neck, however, the spinal cord was caught between the hypertrophic anterior arch of the atlas and posterior part of the slipped pedicle of the axis on the contralateral side. The spinal cord was transformed into a pear shape. Mechanical injury to the spinal cord seemed to explain her neurological presentation. This is, to the authors' knowledge, the 15th case of axial spondylolysis and the sixth case of spinal cord involvement of the cervical spondylolysis. No cases involving myelopathy secondary to such a unique mechanism have been reported previously in the literature.- - - - - - - - - - ranking = 0.021749237031951keywords = compression (Clic here for more details about this article) |
8/35. Bilateral spondylolysis and associated dysplasia of C6.Cervical spondylolysis is a rare condition, characterised by the presence of a corticated cleft between the superior and inferior articular facets of the articular mass (1). This defect involves the cervical equivalent of the pars interarticularis of the lumbar spine. Associated dysplastic changes are present, suggesting that the lesion is congenital (1 and 2). This case report describes bilateral spondylolysis and associated dysplasia of C6 in an 18 year old female. The importance of this lesion lies in its differentiation from the more serious articular mass fracture or dislocation (1).- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
9/35. Failure of operative treatment in a fast bowler with bilateral spondylolysis.Modern day fast bowling places immense strain on the spine. Stress fractures of the lumbar region are common. If a period of conservative treatment fails to return a fast bowler to professional sport, surgery is considered. Good results have been reported using a direct screw repair of the spondylolytic defect. A case is presented of a failed surgical intervention with an alternative technique.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
10/35. Dissociation between back pain and bone stress reaction as measured by CT scan in young cricket fast bowlers.BACKGROUND: Bone stress reaction is prevalent among cricket fast bowlers. Few studies have addressed the sensitivity and specificity of imaging for diagnosis, and follow up assessment has been poorly investigated. OBJECTIVE: To determine whether there was an association between back pain and bone stress reaction as measured by computed tomography (CT) scan in young cricket fast bowlers. methods: Ten young cricket fast bowlers were included in the study. Nine bowlers presented to a physiotherapy practice with low back pain and were later diagnosed with lumbar stress fractures, while one was an experienced bowler with no pain. All players had a CT scan after presenting to the physiotherapy practice. Pain was assessed according to a subjective scale (0-10) where 10 represented the player's subjective, maximum pain score. Recovery and rehabilitation of all players was monitored until they returned to full participation. RESULTS: There was no consistency in the relationship between pain and CT scan results. For example, one subject had evidence of un-united stress fractures after 15 months of rest but had experienced moderate pain for only 2 weeks after the onset of symptoms, in contrast to another subject who had intermittent pain for 11 months even though CT scan showed multiple stress fractures ranging from partially healed to fully healed status at 3 months. CONCLUSION: There is dissociation between back pain and bone stress reaction as measured by CT scan. Therefore, CT scan does not provide objective evidence for ongoing management or decision concerning return to sport in cricket fast bowlers.- - - - - - - - - - ranking = 3keywords = fracture (Clic here for more details about this article) |
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