Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-10-2009 | Basic Science

Newly occurred L4 spondylolysis in the lumbar spine with pre-existence L5 spondylolysis among sports players: case reports and biomechanical analysis

Authors: Koichi Sairyo, Toshinori Sakai, Natsuo Yasui, Ali Kiapour, Ashok Biyani, Nabil Ebraheim, Vijay K. Goel

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2009

Abstract

Study design

Case series and a biomechanical study using a finite element (FE) analysis.

Objectives

To report three cases with multi-level spondylolysis and to understand the mechanism biomechanically.

Background

Multi-level spondylolysis is a very rare condition. There have been few reports in the literature on multi-level spondylolysis among sports players.

Methods

We reviewed three cases of the condition, clinically. These patients were very active young sports players and had newly developed fresh L4 spondylolysis and pre-existing L5 terminal stage spondylolysis. Thus, we assumed that L5 spondylolysis may have increased the pars stress at the cranial adjacent levels, leading to newly developed spondylolysis at these levels. Biomechanically, we investigated pars stress at L4 with or without spondylolysis at L5 using the finite element technique.

Results

L4 pars stress decreased in the presence of L5 spondylolysis, which does not support our first hypothesis.

Conclusions

It seems that multi-level spondylolysis may occur due to genetic and not biomechanical reasons.

Albanese M, Pizzutillo PD (1982) Family study of spondylolysis and spondylolisthesis. J Pediatr Orthop 2:496–499PubMed

Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP (1984) The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 66:699–707PubMed

Fujii K, Katoh S, Sairyo K, Ikata T, Yasui N (2004) Union of defects in the pars interarticularis of the lumbar spine in children and adolescents. J Bone Joint Surg Br 86:225–231. doi:10.1302/0301-620X.86B2.14339 PubMedCrossRef

Goel V, Grauer J, Patel T, Biyani A, Sairyo K, Vishnubhotla S et al (2005) Effects of charite artificial disc on the implanted and adjacent spinal segments mechanics using a hybrid testing protocol. Spine 30(24):2755–2764. doi:10.1097/01.brs.0000195897.17277.67 PubMedCrossRef

Haukipuro K, Keränen N, Koivisto E, Lindholm R, Norio R, Punto L (1978) Familial occurrence of lumbar spondylolysis and spondylolisthesis. Clin Genet 13(6):471–476PubMed

Laurent LE, Osterman K (1969) Spondylolisthesis in children and adolescents: a study of 173 cases. Acta Orthop Belg 35:717–727PubMed

Miyagi S, Yano T, Ikari T, Hirakawa S (1967) Survey on familial background of spondylolysis. Seikei Geka (Japanese) 18(1):32–37

Ravichandran G (1980) Multiple lumbar spondylolyses. Spine 5:552–557PubMedCrossRef

Sairyo K, Biyani A, Goel VK, Leaman D, Booth R, Thomas J et al (2005) Pathomechanism of ligamentum flavum hypertrophy: a multidisciplinary investigation based on clinical, biomechanical, histological, and biological assessments. Spine 30(23):2649–2656. doi:10.1097/01.brs.0000188117.77657.ee PubMedCrossRef

10.

Sairyo K, Goel VK, Faizan A, Vadapalli S, Biyani S, Ebraheim N (2006) Buck’s direct repair of lumbar spondylolysis restores disc stresses at the involved and adjacent levels. Clin Biomech (Bristol, Avon) 21(10):1020–1026CrossRef

11.

Sairyo K, Goel VK, Masuda A, Biyani A, Ebraheim N, Mishiro T et al (2005) Biomechanical rationale of endoscopic decompression for lumbar spondylolysis as an effective minimally invasive procedure—a study based on the finite element analysis. Minim Invasive Neurosurg 48:119–122. doi:10.1055/s-2004-830223 PubMedCrossRef

12.

Sairyo K, Goel VK, Masuda A, Vishnubhotla S, Biyani A, Ebraheim N et al (2006) Three dimensional finite element analysis of the pediatric lumbar spine. Part II: biomechanical change as the initiating factor for pediatric isthmic spondylolisthesis at the growth plate. Eur Spine J 15:930–935. doi:10.1007/s00586-005-1033-0 PubMedCrossRef

13.

Sairyo K, Goel VK, Vadapalli S, Vishnubhotla S, Biyani A, Ebraheim N et al (2006) Biomechanical comparison of lumbar spine with or without spina bifida occulta. A finite element analysis. Spinal Cord 44(7):440–444PubMed

14.

Sairyo K, Katoh S, Sasa T, Yasui N, Goel VK, Vadapalli S et al (2005) Athletes with unilateral spondylolysis are at risk of stress fracture at the contra-lateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med 33(4):583–590. doi:10.1177/0363546504269035 PubMedCrossRef

15.

Sairyo K, Katoh S, Takata Y, Terai T, Yasui N, Goel VK et al (2006) MRI signal changes of the pedicle as an indicator for early diagnosis of spondylolysis in children and adolescents. A clinical and biomechanical study. Spine 31:206–211. doi:10.1097/01.brs.0000195161.60549.67 PubMedCrossRef

16.

Sakai T, Sairyo K, Takao S, Hirohashi N, Higashino K, Katoh S et al (2007) Incidence of spondylolysis in Japanese population. Tokushima Spine Conference, Tokushima

17.

Sakai T, Yamada H, Nakamura T, Nanamori K, Kawasaki Y, Hanaoka N et al (2006) Lumbar spinal disorders in patients with athetoid cerebral palsy: a clinical and biomechanical study. Spine 31(3):E66–E70. doi:10.1097/01.brs.0000197650.77751.80 PubMedCrossRef

18.

Sakamaki T, Katoh S, Sairyo K (2002) Normal and spondylolytic pediatric spine movements with reference to instantaneous axis of rotation. Spine 27(2):141–145. doi:10.1097/00007632-200201150-00004 PubMedCrossRef

19.

Tower SS, Pratt WB (1990) Spondylolysis and associated spondylolisthesis in Eskimo and Athabascan populations. Clin Orthop Relat Res 250:171–175PubMed

20.

Wiltse LL, Wildell EH Jr, Jackson DW (1975) Fatigue fracture. The basic lesion in isthmic spondylolisthesis. J Bone Joint Surg Am 57:17–22PubMed

21.

Young KJ, Koning W (2003) Spondylolysis of L2 in identical twins. J Manipulative Physiol Ther 26(3):196–201. doi:10.1016/S0161-4754(02)54133-6 PubMedCrossRef

Title: Newly occurred L4 spondylolysis in the lumbar spine with pre-existence L5 spondylolysis among sports players: case reports and biomechanical analysis
Authors: Koichi Sairyo
Toshinori Sakai
Natsuo Yasui
Ali Kiapour
Ashok Biyani
Nabil Ebraheim
Vijay K. Goel
Publication date: 01-10-2009
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 10/2009
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-008-0795-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Newly occurred L4 spondylolysis in the lumbar spine with pre-existence L5 spondylolysis among sports players: case reports and biomechanical analysis

Abstract

Study design

Objectives

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Study design

Objectives

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2009

Reconstruction of the proximal humerus with a composite of extracorporeally irradiated bone and endoprosthesis following excision of high grade primary bone sarcomas

Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail

Early results in the treatment of proximal humeral fractures with a polyaxial locking plate

Behaviour of nonresorbable bioactive glass–ceramic implanted into long bone defects: comparison with cancellous allografts

New technique for knee flexion contracture with patella infera using patellar tendon reconstruction combined with anterior capsular shift: a case report

Treatment of lateral epicondilitis using three different local injection modalities: a randomized prospective clinical trial