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.

A Multimodal Treatment Approach on Rare Case of Meningomyelocele

Meningomyelocele, one of the neural tube defect (NTD) variants, is a condition in which meninges and neural tissue protrudes through a defect in vertebral arch and forms a cyst-like sac with an incidence of 0.5–11/1000 live births. Hydrocephalus is a major problem for majority of patients with meningomyelocele due to the abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain. Meticulous preoperative evaluation with planning of the anesthetic technique, especially in regard to managing the airway, plays a crucial role in successful surgical management of these cases. Here, we report a case of lumbosacral meningomyelocele with hydrocephalus underwent a multimodal treatment approach for providing a comprehensive plan of care.

Assessment of new method of posterior spinal fusion in the treatment of patients with posttraumatic kyphotic deformity of the thoracic and lumbar spine

Objective. To carry out a comparative analysis of two methods of the posterior bone block formation (with autograft bone chips or with a whole vertebral arch) and to assess the rate of bone block formation, the degree of surgery invasiveness and the patient-reported cosmetic satisfaction with the results.Material and Methods. The study involved 31 patients with kyphotic deformity of the thoracic spine, of which 15 patients underwent spinal fusion using autograft bone chips (control group), and 16 were operated on using a new technique with a whole vertebral arch. The results of treatment were assessed using a modified MacNab scale. During the follow-up period from 1.5 to 2 years, pain syndrome was assessed according to VAS, quality of life according the Oswestry Disability Index, and cosmetic satisfaction was assessed using the SRS-22 scale.Results. In the course of the work, it was revealed that in patients who were operated on using new method, the time of bone block formation according to CT data was shorter, the overall satisfaction with surgery result was higher (mainly due to the absence of a cosmetic defect), and the indicators of the operation duration and blood loss did not differ compared to those in the control group.Conclusion. Based on the results obtained, spinal fusion using a whole vertebral arch can be recommended in clinical practice for surgical interventions in patients with kyphotic deformities of the spine.

Management of Pediatric Patients with Spina Bifida

Spina bifida is a neurodevelopmental disorder and belong to most common congenital malformations. It is a neural tube defect that originates within first 28 days after conception. Although survival rate of these patients had changed rapidly within last decades, neural tube defects are still cause of substantial part of children morbidity. Occult type of spina bifida is a simple nonunion of vertebral arch without causing any symptoms. Open defects according to degree of involvement of neural tissue cause symptoms such as paralysis of lower extremities, bladder and bowel morbidity, delay in development of cognitive functions of various severity and other possible complications affecting morbidity of these patients. Early diagnosis and treatment of open spina bifida and accompaying complications is crucial and largely affects the outome. Succesfull treatment requires lifelong cooperation of a whole range of specialists and guiding of treatment by primary care doctor. Survival and quality of life are associated with acces to proper medical and surgical treatment as well as community support systems. This chapter offers overview of this topic with emphasis on general management of patients suffering from this congenital malformation.

Congenital Bilateral and Multifocal Mesenchymal hamartoma of the chest wall: A Case in a Neonate and Differential Diagnosis

Background:Mesenchymal hamartoma of the chest wall(MHCW) is a rare benign extrapleural lesion that arises from rib or spine of neonates or early infancy, and commonly presents as a unilateral mass. Here, we describe a rare case of bilateral and multifocal MHCW in the right 5th rib and the left 11-12th thoracic and 1st lumbar vertebrae.Case presentation:A male neonate of 3700g weight transferred to our hospital with mild respiratory distress and an asymptomatic, progressively enlarging intra-thoracic mass. Computed tomography scan(CT) and magnetic resonance imaging(MRI) indicated a large well-circumscribed, heterogeneous enhancing mass, arising from the posterior-medial aspect of the right chest wall, involving 3-5th posterior ribs. Other smaller sizes lesions observed in vertebral arch and transverse process of the left 11-12th thoracic and 1st lumbar vertebrae. The thoracotomy with en bloc resection of the mass and the 5th rib was performed. Microscopically, the lesion was cystic and solid, consisted of hyaline cartilages, mesenchymal cells, and various-sized hemorrhagic spaces. Immunohistochemically, the cartilages and mesenchymal cells were positive for S-100, Smooth Muscle Actin(SMA), CD163 and CD68. The epithelium cells of aneurysmal bone cyst(ABC)-like were negative for CD34. Ki-67 estimated at 5%-10%. Fluorescence in situ hybridization(FISH) was negative for USP6 gene break-apart probe, which ruled out primary ABC. At 8-month follow-up postoperatively, the right chest walls with no sign of recurrence and the lesions of left vertebral arch and transverse process were stable, no increased in size.Conclusion:The bilateral and multifocal MHCW is considerably rare and related clinical research is limited. Fortunately, we clearly observed the tumor’s origin, growth process from the earlier pregnancy to delivery, different effects during the fetal periods, and differential diagnosis. This report may raise awareness regarding the MHCW.

Increased sagittal diameter of the vertebral arch aids in diagnosis of lumbar spondylolysis

Objective To identify a diagnostic indicator of lumbar spondylolysis visible in plain X-ray films. Methods One hundred and seventy-two patients with low back pain who received X-ray and computerized tomography (CT) examinations were identified and studied. They were divided into three groups: the spondylosis without spondylolisthesis (SWS) group, comprising 67 patients with bilateral pars interarticularis defects at L5 and without spondylolisthesis, the isthmic spondylolisthesis (IS) group, comprising 74 patients with L5/S1 spondylolisthesis and bilateral L5 pars interarticularis defects, and the control group, comprising 31 patients with low back pain but without spondylolysis. The sagittal diameters of the vertebral arch (SDVAs) of L4 and L5 were measured in lateral X-ray image, and the differences in SDVA between L4 and L5 (DSL4-5) in each case were calculated and analyzed. Results There were no significant differences in demographic characteristics among the three groups. In the SWS and IS groups, the SDVA of L5 was significantly longer than the SDVA of L4 (p < 0.001), whereas no significant difference found in the control group (p > 0.05). DSL4-5, in which the SDVA of L4 was subtracted from the SDVA of L5, significantly differed among the three groups (p < 0.001), and the normal threshold was provisionally determined to be 1.55 mm. Conclusions In bilateral L5 spondylolysis, the SDVA of L5 is wider than the SDVA of L4, and this difference is greater in isthmic spondylolisthesis. This sign in lateral X-rays may provide a simple and convenient aid for the diagnosis of spondylolysis.

Developmental anomalies of the lateral portion of the cervical neural arch: Multimodal imaging and clinical implications

Objective This study aimed to describe the imaging spectrum of developmental anomalies of the lateral portion of the cervical neural arch. Method This was a five-year retrospective review of consecutive computed tomography (CT) scans of the cervical spine for structural anomalies of the cervical vertebral pedicle and facets. CT, radiographs and, when available, magnetic resonance imaging studies were independently reviewed. Anomalies were grouped into the following three categories: the absence of a pedicle, clefts in the vertebral arch or isolated dysmorphism of the facet. Clinical data on demographics and neurological outcomes were documented. Results Among 9134 consecutive patients undergoing a CT scan of the cervical spine, 18 (0.2%) patients were found to have developmental anomalies of the pedicle and facets. Findings included 7/18 (39%) with congenital absence of a pedicle, 8/18 (44%) with clefts in the vertebral arch and 3/18 (17%) with isolated dysmorphism of the articular facets. No acute neurological deficits or spinal cord injuries were reported. Associated chronic symptoms included neck pain 10/18 (56%), radiculopathy 7/18 (39%) and myelopathy 1/18 (6%). Conclusion Developmental anomalies of the pedicle and facet may mimic traumatic spinal pathologies. Recognising a diverse spectrum of imaging findings is vital to prevent misdiagnosis and unnecessary intervention.