Effect of lumbar lordosis angle in adolescent baseball players on the development of lumbar spondylolysis v1

Background: Lumbar spondylolysis is a stress fracture of the lumbar vertebral arch that occurs frequently in adolescents. Lumbar spondylolysis has a high prevalence in athletes, especially baseball players. When lumbar spondylolysis occurs, restriction of sports activities is inevitable until the bony union is achieved. Therefore, prevention of the onset of lumbar spondylolysis is necessary, and it is necessary to elucidate the risk factors that influence the onset of the disease. An increase in lumbar lordosis angle may influence the development of lumbar spondylolysis because the lumbar lordosis angle increases the compressive stress in the vertebral arch. However, there are no reports on the effect of lumbar lordosis angle and the development of lumbar spondylolysis in adolescent baseball players. Therefore, the purpose of this study was to investigate the effect of lumbar lordosis angle on the development of lumbar spondylolysis in adolescent baseball players. METHODS: Eligible patients were those who visited the orthopedic clinic from January 1, 2018, to October 31, 2021. The selection criteria were male baseball players aged 11-18 years who visited the clinic, and the exclusion criteria were those whose superior endplate of L1 and superior endplate of S1 could not be identified in the MRI images. The existence of development of lumbar spondylolysis, lumbar lordosis angle, age, and pitching experience of the above patients will be assessed based on electronic medical records and imaging findings. Statistical analysis was performed using logistic regression analysis, with the objective variable being the existence of lumbar spondylolysis and the explanatory variables being the lumbar lordosis angle, age, and previous pitching experience.Discussion: This study examines the effect of the lumbar lordosis angle on the development of lumbar spondylolysis in adolescent baseball players. An increase in lumbar lordosis angle may influence the development of lumbar spondylolysis and may be a risk factor for the development of lumbar spondylolysis.

Characteristics of Recurrent Cases after Conservative Therapy in Adolescent Lumbar Spondylolysis

Purpose: Occasionally lumbar spondylolysis in adolescents will recur after conservative treatment. The goal of this study was to retrospectively review the conditions in which recurrence transpired in a subset of adolescent patients diagnosed with acute lumbar spondylolysis. Subjects: A retrospective survey was conducted in 152 patients who had been treated for spondylolysis and had obtained bone union. Twenty subjects were selected who had recurrent lumbar spondylolysis after returning to sports activity following the first spondylolysis treatment. There were 18 males and two females with an average age at the time of initial consultation of 13.3 years and 14.1 years at the time of recurrence.Results: The average period of initial treatment was 101 days, and the average time to recurrence after healing was 149 days. There were three cases at L3, two cases at L4 and 15 cases at L5. At recurrence, 18 patients had unilateral involvement and two patients presented with bilateral occurrence. Four cases did not achieve bony union.Discussion: In this study, the recurrence rate was 13.2%. Eighty percent of cases had recurrence within six months after healing. After recurrence, 20% of the cases reached pseudoarthrosis. It is useful to take regular MRI images to detect recurrence within six months after returning to sports.

Role of low-intensity pulsed ultrasound on lumbar spondylolysis: a systematic review

Objective: To systematically review the role of low-intensity pulsed ultrasound on lumbar spondylolysis. Method: Literature search was conducted on PubMed, Embase, CINAHL, Web of Science, PEDro and Scopus databases to identify relevant studies published between 2010 and 2020 by using medical subject headings and applying Booleans, such as low-intensity pulsed ultrasound OR interventional ultrasound AND lumbar spine OR lumbar region AND spondylolysis OR stress fracture. Unpublished studies were hand-searched in the journals, abstracts of conferences were reviewed, and citation index was used for searching experts in the field and then contacting them for information. Studies included were the ones that had at least one of the following outcomes: bone union rate, treatment period to bone union and time to return to previous activities. Results: Of the 243 studies identified, 228(94%) were full text articles and only 2(0.8%) studies were critically appraised for qualitative synthesis based on bone union rate, treatment period to bone union, and time to return to previous activities. Conclusion: Low-intensity pulsed ultrasound was found to be effective for bone union and a useful therapy for quick return to playing sports in patients with lumbar spondylolysis. Key Words: Lumbar region, Spondylolysis, Interventional ultrasound, Systematic review.

Risk-Factor Analysis of Disc and Facet Joint Degeneration After Inter-Segmental Pedicle Screw Fixation for Lumbar Spondylolysis

Background: To assess the effects of inter-segment pedicle screw fixation for the treatment of lumbar spondylolysis, and evaluate various risk factors potentially predicting the probability of disc and facet joint degeneration after instrumentation.Methods: The study included 54 male L5 spondylolysis patients who underwent pars repair and inter-segment fixation using pedicle screws. Bony union was evaluated using reconstruction images of computed tomography. Radiographic changes including the disc height, vertebral slip, facet joint and disc degeneration in the grade of adjacent and fixed segments were determined from before to final follow-up. Logistic regression analysis was performed to identify factors associated with the incidence of disc and facet joint degeneration.Results: Bony union was achieved in all cases. Logistic regression analysis revealed that duration of instrumentation of more than 15.5 months and 21.0 months were significant risk factor of the incidence of L4/5 and L5S1 facet degeneration, respectively. Conclusions: Inter-segmental pedicle screw fixation provides good surgical outcomes and good isthmic bony union rates in patients with lumbar spondylolysis. The duration of fixation was confirmed as a risk factor of facet joint degeneration. Once bony union is achieved, remove of the instruments should be recommended.