1/91. spondylolysis at three sites in the same lumbar vertebra. We report a rare case of spondylolysis that occurred at 3 sites in the fifth lumbar vertebra involving the bilateral pars interarticularis and the center of the right lamina. This is the first such case in the world literature. ( info) |
2/91. Retrodural cysts bridging a bilateral lumbar spondylolysis: a report of two symptomatic cases. We report the MR features in two patients presenting with symptomatic thecal impingement by posterior epidural cysts linking a bilateral lumbar spondylolysis. Large fluid-filled channels bridging the ruptured partes interarticulares were present in spite of the absence of significant arthritic changes within the adjacent facet joints. ( info) |
3/91. 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. ( info) |
4/91. 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. ( info) |
| low back pain (LBP) has recently become a common complaint in swimmers. The differential diagnosis of LBP in swimmers includes muscle and ligament sprains, Scheuerman disease, herniated disc, facet joint injury, tumors, infections, and spondylolysis. Although spondylolysis or listhesis is a frequent injury in the athlete, mainly in weightlifters, wrestlers, gymnasts, divers and ballet dancers, it is infrequently reported in swimmers. We have recently encountered four adolescent elite swimmers who complained of low back pain and were diagnosed as having spondylolysis. Three of the patients were either breast-strokers or butterfly swimmers. Plain radiography demonstrated the lesion in two patients. Increased uptake in bone scan was noted in all patients. CT was performed only in two patients and revealed the lesion in both. One patient was diagnosed within two weeks, and the diagnosis in the others was deferred for 2-7 months. The patients were treated successfully by reducing the intensity of their training program and the use of a corset for at least three months. Repeated hyperextension is one of the mechanisms for spondylolysis in athletes as is the case in breast-strokers and butterfly style swimmers. LBP in swimmers should raise the suspicion of spondylolysis. Plain radiography and bone scan should be performed followed by SPEC views, CT, or MRI as indicated. If the case is of acute onset as verified by bone scan, a boston or similar brace should be used for 3 to 6 months in conjunction with activity modification and optional physical therapy. Multidisciplinary awareness of low back pain in swimmers, which includes trainers, sport medicine physicians, and physical therapists, should lead to early diagnosis and appropriate treatment. ( info) |
6/91. 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. ( info) |
7/91. Tunneling Schmorl's nodes in an elderly woman treated for acute lymphoblastic leukemia. We present a 70-year-old woman with pre-B acute lymphoblastic leukemia in whom serial imaging studies showed the development of multiple vertebral collapse, and communicating superior and inferior Schmorl's nodes creating a longitudinal channel ("tunneling" Schmorl's nodes) through the anterior aspect of T12 to L3 vertebral bodies of her osteoporotic thoracolumbar spine. This was observed after achieving complete remission of the disease and during maintenance therapy. The finding is felt to be secondary to iatrogenic exacerbation of osteoporosis. ( info) |
8/91. Management of multiple level spondylolysis of the lumbar spine in young males: a report of six cases. The most common procedure for surgical treatment of lumbar spondylolysis is intertransverse processes spinal arthrodesis with instrumentation. However, this procedure is associated with significant morbidity on long-term follow up. Direct repair of spondylolysis is an alternative method for preservation of motion segment and anatomic continuity in young adults with multiple level spondylolysis. From 1992 through 1998, six soldiers with a diagnosis of multiple level spondylolysis who complained of persistent low back pain were treated in our hospital. spondylolysis involved two levels in five cases and three levels in one case. All patients underwent serial roentgenography of the lumbar spine and a staged pars interarticularis infiltration test with bupivacain 0.5%. Five patients underwent direct repair of the pars interarticularis defects with hook screws, translaminar screws, and bone graft, while one patient received conservative treatment. All surgically treated patients had either good or excellent results at a mean of 34.4 months follow-up. One patient who was treated nonsurgically still complained of sport restriction at 16 months follow-up. Direct repair of multiple pars interarticularis defects after a positive staged pars infiltration test can restore anatomic stability, relieve back pain, and preserve a greater range of motion of the lumbar spine in young patients with intact disc height. ( info) |
9/91. Combined dysplastic and isthmic spondylolisthesis: possible etiology. STUDY DESIGN: Four cases of combined dysplastic and higher-level isthmic spondylolisthesis were studied. OBJECTIVE: To attempt to understand the possible etiology of this unreported combination. SUMMARY OF BACKGROUND DATA: Dysplastic spondylolisthesis is thought to be hereditary. It is believed that isthmic spondylolisthesis, the more common type, is acquired. Multiple spondylolysis and spondylolisthesis have been reported, but no cases of combined dysplastic and isthmic spondylolisthesis. methods: The global and segmental Cobb angles of the lumbar vertebrae and sagittal vertical alignment were measured in four patients who presented with lower back pain and varying degrees of pain radiation to the lower limb. Posteroanterior and lateral radiographs were taken with patients standing barefooted. Three of the patients underwent surgery. The fourth patient refused surgery. RESULTS: The global and segmental Cobb angles were found significantly increased in these patients. Increased segmental extension angles were clearer at the levels above the dysplastic vertebrae and at the level of the isthmic defect. Large anterior translation of the thorax was noted in all cases. CONCLUSIONS: The authors believe that this unusual combination may have resulted from hyperlordosis occurring above the dysplastic vertebrae, which caused increased stresses that led to the isthmic defect. This combination should be investigated in patients with dysplastic spondylolisthesis and hyperlordosis. ( info) |
10/91. Multiple lower lumbar spondylolyses. A case is reported in which there was bilateral spondylolysis involving LV3, LV4 and LV5. It is thought that the condition is due to postural stress in a patient having a predisposing genetic weakness of the pars interarticularis. ( info) |