Pars Interarticularis Defect

Objective.Gout typically affects the peripheral joints of the appendicular skeleton and rarely involves the axial joints. The literature on axial gout is limited to case reports and case series. This preliminary study was conducted to identify the frequency and characteristics of axial gout.Methods.Six hundred thirty medical records with ICD codes 274.0, 274.82, and 274.9 for peripheral gout were reviewed. Ninety-two patients had clinical or crystal-proven gout, of which 64 had prior computed tomography (CT) images of the spine performed for various medical reasons. These CT images were reviewed for features of axial gout, which include vertebral erosions mainly at the discovertebral junction and the facet joints, deposits of tophi, and erosions in the vertebral body, epidural space, ligamentum flavum and pars interarticularis.Results.Nine of the 64 patients had radiographic changes suggestive of axial gout. Lumbar vertebrae were most commonly involved, with facet joint erosions being the most common finding. Isolated involvement of the sacroiliac joints was seen in 2 patients. Axial gout had been diagnosed clinically in only one patient.Conclusion.Radiologic changes of axial gout were more common than recognized clinically, with a frequency of 14%. Since not all patients had CT images, it is possible that the frequency of axial involvement was even greater. A prospective study is needed to further define this process.

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An Experimental Model of Adult-Onset Slip Progression in Isthmic Spondylolisthesis

10.1115/imece2001/bed-23042 ◽

2001 ◽

Author(s):

Avinash G. Patwardhan ◽

James Simonds ◽

Alexander J. Ghanayem ◽

Leonard Voronov ◽

Arif Ali ◽

...

Keyword(s):

Experimental Model ◽

Common Type ◽

Leg Pain ◽

Low Back ◽

Isthmic Spondylolisthesis ◽

Adult Onset ◽

Pars Interarticularis ◽

The One ◽

Lumbar Spondylolisthesis

Abstract Spondylolisthesis is defined as a slippage of a vertebral body on the one below. Isthmic spondylolisthesis, caused by stress fracture or a developmental anomaly at the pars interarticularis, is the most common type of lumbar spondylolisthesis with a 6% incidence in adults. Isthmic lumbar spondylolisthesis is a frequent cause of disabling low-back and leg pain. The goal of this study is to improve the quality of treatment of these patients.

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THE COMPARISION OF RADIOLOGICAL DISTANCE DIFFERENCE BETWEEN THE PARS INTER-ARTICULARIS AND PEDICLE, AS A REPRODUCIBLE AND CONSISTENT GUIDE FOR PEDICULAR SCREW FIXATION TECHNIQUE, IN SPINAL LUMBAR SURGERIES.

10.36106/9713874 ◽

2021 ◽

pp. 61-63

Author(s):

Bharath. V ◽

Hemanth Kumar ◽

Ashwanth Narayan ◽

Venkatachalam .K ◽

Ashwin. VY ◽

...

Keyword(s):

Ct Images ◽

Steady Increase ◽

Lateral Border ◽

X Ray ◽

Screw Insertion ◽

Pedicular Screw ◽

Pars Interarticularis ◽

Upward Direction ◽

Anatomical Relationship ◽

Distance Difference

The Inter-Pedicular and Inter-Pars distance was measured in a plain AP radiography (X-Ray) of 150 and 75 CT images normal patients between 18- 47 years of age. The aim of the study is to measure the normal Inter-Pedicular and Inter-Pars distance. We found that by studying the anatomical relationship between the inner or medial Pedicular border and the Pars outer or lateral border, gives the Orthopaedic Surgeon a reproducible and consistent guide towards exacting a pedicular screw placing. We found that both X-Ray and CT images shows steady increase in the Ipr and Ipd from L1 to L5, there is a minimal difference from L1-L2 and marked difference seen from L3 to L5, and showing the differences in distances are more in the males, compared to females. The Means of all the groups compared also proves that there is steady raise in the diameter of the IPR and IPD from L1 to L5, where there is dramatical and signicant change in the upward direction, noted from L3 to L5. The mean difference is almost constant from L1to L2. So this study, did essentially to help, establish that, the inner medial border of pedicle, is in near relationship to, the outer lateral border of the Pars-Interarticularis, which helps in establishing the latero-medial entry point for the pedicular screw insertion in the lumbar spine.

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The association of lumbosacral transitional vertebral anomalies with acetabular dysplasia in adult patients with hip-spine syndrome

The Bone & Joint Journal ◽

10.1302/0301-620x.103b8.bjj-2020-2481.r1 ◽

2021 ◽

Vol 103-B (8) ◽

pp. 1351-1357

Author(s):

Joshua Sun ◽

Avneesh Chhabra ◽

Uma Thakur ◽

Louis Vazquez ◽

Yin Xi ◽

...

Keyword(s):

Acetabular Dysplasia ◽

Intraclass Correlation ◽

Final Diagnosis ◽

Hip Pain ◽

Pars Interarticularis ◽

Vertebral Anomalies ◽

Lumbosacral Transitional Vertebra ◽

Standard Radiographs ◽

Time Of Presentation ◽

The Relationship

Aims Some patients presenting with hip pain and instability and underlying acetabular dysplasia (AD) do not experience resolution of symptoms after surgical management. Hip-spine syndrome is a possible underlying cause. We hypothesized that there is a higher frequency of radiological spine anomalies in patients with AD. We also assessed the relationship between radiological severity of AD and frequency of spine anomalies. Methods In a retrospective analysis of registry data, 122 hips in 122 patients who presented with hip pain and and a final diagnosis of AD were studied. Two observers analyzed hip and spine variables using standard radiographs to assess AD. The frequency of lumbosacral transitional vertebra (LSTV), along with associated Castellvi grade, pars interarticularis defect, and spinal morphological measurements were recorded and correlated with radiological severity of AD. Results Out of 122 patients, 110 (90.2%) were female and 12 (9.8%) were male. We analyzed the radiographs of 122 hips (59 (48.4%) symptomatic left hips, and 63 (51.6%) symptomatic right hips). Average age at time of presentation was 34.2 years (SD 11.2). Frequency of LSTV was high (39% to 43%), compared to historic records from the general population, with Castellvi type 3b being the most common (60% to 63%). Patients with AD have increased L4 and L5 interpedicular distance compared to published values. Frequency of pars interarticularis defect was 4%. Intraclass correlation coefficient for hip and spine variables assessed ranged from good (0.60 to 0.75) to excellent (0.75 to 1.00). Severity of AD did not demonstrate significant correlation with frequency of radiological spine anomalies. Conclusion Patients with AD have increased frequency of spinal anomalies seen on standard hip radiographs. However, there exists no correlation between radiological severity of AD and frequency of spine anomalies. In managing AD patients, clinicians should also assess spinal anomalies that are easily found on standard hip radiographs. Cite this article: Bone Joint J 2021;103-B(8):1351–1357.

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MDP-SPECT Versus Hybrid MDP-SPECT/CT in the Evaluation of Suspected Pars Interarticularis Fracture in Young Athletes

Journal of Neuroimaging ◽

10.1111/jon.12533 ◽

2018 ◽

Vol 28 (6) ◽

pp. 635-639 ◽

Cited By ~ 1

Author(s):

Santhosh Gaddikeri ◽

Manuela Matesan ◽

Jacqueline Alvarez ◽

Daniel S. Hippe ◽

Hubert J. Vesselle

Keyword(s):

Young Athletes ◽

Pars Interarticularis

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The anatomic rationale for transforaminal endoscopic interbody fusion: a cadaveric analysis

Neurosurgical FOCUS ◽

10.3171/2015.10.focus15389 ◽

2016 ◽

Vol 40 (2) ◽

pp. E12 ◽

Cited By ~ 15

Author(s):

Mitchell Hardenbrook ◽

Sergio Lombardo ◽

Miles C. Wilson ◽

Albert E. Telfeian

Keyword(s):

Surface Area ◽

Soft Tissues ◽

Safe Zone ◽

Large Area ◽

Nerve Roots ◽

Disc Space ◽

Endoscopic Techniques ◽

Pars Interarticularis ◽

The Mean ◽

Cadaveric Analysis

OBJECTIVE The authors describe a cadaveric analysis to determine the ideal dimensions and trajectory for considering endoscopic transforaminal interbody implantation. METHODS The soft tissues of 8 human cadavers were removed from L-1 to the sacrum, exposing the posterior bony elements. Facetectomies were performed bilaterally at each lumbar level with resection of the pars interarticularis, revealing the pedicles, nerve roots, and interbody disc space. Each level was digitally photographed with a marker for scale and evaluated with digital analysis software. The traversing and exiting nerve roots and pedicle margins were identified, and the distances between these structures and their relationships to the surrounding structures were documented. RESULTS The dimensions of 2 areas were measured: the working triangle and safe zone. The working triangle is the triangle between the exiting and traversing nerve roots above the superior margin of the inferior pedicle. The safe zone is the trapezoid bounded by the widths of the superior and inferior pedicles between the exiting and traversing nerve roots. The mean surface area for the working triangle was 1.83 cm2, with L5–S1 having the largest area at 2.19 cm2. The mean surface area of the safe zone was 1.19 cm2, with L5–S1 having the largest area at 1.26 cm2. At the medial border of the pedicle extending superiorly, there were no nerve structures within 1.19 cm at any level. On the lateral border of the pedicle, the exiting nerve root was closer superiorly, with the closest being 0.3 cm. CONCLUSIONS The working triangle is a relatively large area. The safe zone, just superior to the pedicle, is free of nerve structures. By utilizing the superior border of the pedicle, the disc space can be accessed within this safe zone without risk of injury to the nerves. A thorough understanding of foraminal anatomy is fundamental for considering how to safely access the disc space, thereby utilizing less invasive endoscopic techniques, and is an important first step in considering what shapes and sizes of interbody implants and retractors are feasible for use in the foramen.

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Effect of frameless stereotaxy on the accuracy of C1–2 transarticular screw placement

Journal of Neurosurgery Spine ◽

10.3171/spi.2001.95.1.0074 ◽

2001 ◽

Vol 95 (1) ◽

pp. 74-79 ◽

Cited By ~ 17

Author(s):

Orin Bloch ◽

Langston T. Holly ◽

Jongsoo Park ◽

Chinyere Obasi ◽

Kee Kim ◽

...

Keyword(s):

Image Guidance ◽

Vascular Anatomy ◽

Ct Scanning ◽

Screw Placement ◽

Frameless Stereotaxy ◽

Transarticular Screw ◽

Anterior Cortex ◽

Content Type ◽

Pars Interarticularis ◽

Fine Print

Object. In recent studies some authors have indicated that 20% of patients have at least one ectatic vertebral artery (VA) that, based on previous criteria in which preoperative computerized tomography (CT) and standard intraoperative fluoroscopic techniques were used, may prevent the safe placement of C1–2 transarticular screws. The authors conducted this study to determine whether frameless stereotaxy would improve the accuracy of C1–2 transarticular screw placement in healthy patients, particularly those whom previous criteria would have excluded. Methods. The authors assessed the accuracy of frameless stereotaxy for C1–2 transarticular screw placement in 17 cadaveric cervical spines. Preoperatively obtained CT scans of the C-2 vertebra were registered on a stereotactic workstation. The dimensions of the C-2 pars articularis were measured on the workstation, and a 3.5-mm screw was stereotactically placed if the height and width of the pars interarticularis was greater than 4 mm. The specimens were evaluated with postoperative CT scanning and visual inspection. Screw placement was considered acceptable if the screw was contained within the C-2 pars interarticularis, traversed the C1–2 joint, and the screw tip was shown to be within the anterior cortex of the C-1 lateral mass. Transarticular screws were accurately placed in 16 cadaveric specimens, and only one specimen (5.9%) was excluded because of anomalous VA anatomy. In contrast, a total of four specimens (23.5%) showed significant narrowing of the C-2 pars interarticularis due to vascular anatomy that would have precluded atlantoaxial transarticular screw placement had previous nonimage-guided criteria been used. Conclusions. Frameless stereotaxy provides precise image guidance that improves the safety of C1–2 transarticular screw placement and potentially allows this procedure to be performed in patients previously excluded because of the inaccuracy of nonimage-guided techniques.

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Fracture of the Pars Interarticularis in Adolescent Athletes

Journal of Pediatric Orthopaedics ◽

10.1097/01241398-198601000-00009 ◽

1986 ◽

Vol 6 (1) ◽

pp. 40-46 ◽

Cited By ~ 106

Author(s):

Merv Letts ◽

Tom Smallman ◽

Ron Afanasiev ◽

Gerard Gouw

Keyword(s):

Adolescent Athletes ◽

Pars Interarticularis

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