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Koichi Sairyo - One of the best experts on this subject based on the ideXlab platform.
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Degenerative Changes of the Facet Joints in Adults With Lumbar Spondylolysis.
Journal of Spinal Disorders & Techniques, 2020Co-Authors: Yuichiro Goda, Toshinori Sakai, Shoichiro Takao, Taihei Harada, Yoichiro Takata, Kosaku Higashino, Masafumi Harada, Koichi SairyoAbstract:STUDY DESIGN: Radiologic analysis using computed tomography. OBJECTIVES: To analyze the degenerative changes of the facet joints in patients with Spondylolysis in comparison with control subjects. SUMMARY OF BACKGROUND DATA: Defects of the pars interarticularis are thought to result in a reduction of biomechanical stress on adjacent facet joints. Therefore, degenerative changes of the facet joints in patients with Spondylolysis are expected to be less than those in patients without Spondylolysis. METHODS: Abdominal and pelvic multidetector computed tomography scans of 2000 subjects, performed for conditions unrelated to low back pain, were reviewed. A total of 107 patients (37 women and 70 men) with L5 Spondylolysis were identified [Spondylolysis (+) group]. Sex-matched and age-matched controls without Spondylolysis were chosen randomly [Spondylolysis (-) group]. Subjects in the Spondylolysis group were subdivided into either bilateral Spondylolysis or unilateral Spondylolysis groups for comparison with the control group. Four radiologic findings (narrowing, sclerosis, osteophyte, and bone cyst) indicative of degenerative change of the facet joints adjacent to the L5 pars defects were evaluated and the degree of degenerative change was graded by summing the number of degenerative changes (score range, 0-4). The χ test and Mann-Whitney U test were used for statistical analysis. RESULTS: Significantly more degenerative changes in both L4/L5 and L5/S facet joints were found in the Spondylolysis (+) group than in the Spondylolysis (-) group (χ test, P
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prevalence of symptomatic lumbar Spondylolysis in pediatric patients
Orthopedics, 2016Co-Authors: Akihiro Nitta, Toshinori Sakai, Yuichiro Goda, Yoichiro Takata, Kosaku Higashino, Tadanori Sakamaki, Koichi SairyoAbstract:: Lumbar Spondylolysis, a stress fracture of the pars interarticularis, is prevalent in adolescent athletes. Recent advances in diagnostic tools and techniques enable early diagnosis before these fractures progress to complete fractures through the pars. However, because patients often consult family physicians for primary care of low back pain and these physicians may not have access to diagnostic modalities such as magnetic resonance imaging (MRI) and computed tomography, stress fractures can be missed. This study surveyed the prevalence of symptomatic Spondylolysis in pediatric patients who consulted an orthopedic clinic for primary care and investigated whether such acute stress fractures may be overlooked without MRI. The prospective study investigated 264 patients who were younger than 19 years and had low back pain. Of the 153 patients (58.0%) with low back pain persisting for longer than 2 weeks, 136 who agreed to undergo MRI were included in the study. This group included 11 elementary school students, 71 junior high school students, and 54 high school students. The overall prevalence of lumbar Spondylolysis was 39.7% (54 of 136) and was 9.3% in elementary school students (5 of 11, 45.5%), 59.3% in junior high school students (32 of 71, 45.1%), and 31.5% in high school students (17 of 54, 31.5%). All 54 patients with Spondylolysis had a history of athletic activity. Primary care physicians should recognize that approximately 40% of pediatric patients presenting with low back pain persisting for longer than 2 weeks may have Spondylolysis and should consider MRI in those with a history of athletic activity. Because the spine is immature in this age group, almost half of affected elementary school and junior high school students may have lumbar Spondylolysis. [Orthopedics. 2016; 39(3):e434-e437.].
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analysis of mri signal changes in the adjacent pedicle of adolescent patients with fresh lumbar Spondylolysis
European Spine Journal, 2014Co-Authors: Yuichiro Goda, Toshinori Sakai, Yoichiro Takata, Kosaku Higashino, Tadanori Sakamaki, Koichi SairyoAbstract:Purpose The purpose of this study is to investigate a discrepancy between MRI and computed tomography (CT) findings in the spinal level distribution of Spondylolysis. Recent advances in MRI have led to the early diagnosis of Spondylolysis. Therefore, bony healing can be expected before the condition has a chance to worsen. In this study, we used MRI to examine the changes in spinal level signals in the pedicles adjacent to the pars interarticularis in adolescents with fresh lumbar Spondylolysis. We then compared spinal level distribution of Spondylolysis with that of previous results obtained by multidetector CT.
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A remarkable case of hypertrophic pseudoarthrosis of the pars interarticularis in a young American football professional player
European Journal of Orthopaedic Surgery & Traumatology, 2012Co-Authors: Ryo Miyagi, Koichi Sairyo, Toshinori Sakai, Akira DezawaAbstract:Lumbar Spondylolysis is a defect of the pars interarticularis regarded as a stress fracture. The bone stump around the pars defect usually appears atrophic and is fibrously united or filled with fibro cartilaginous mass, similar to long bone pseudoarthrosis. Lumbar Spondylolysis sometimes causes bone growth resembling that of an osteophyte in osteoarthritis, and in elderly patients, the ragged edges result in radiculopathy around the defect. However, lumbar Spondylolysis is rarely reported to cause hypertrophic changes resulting in spinal canal stenosis in young patients. In this report, we present an unprecedented radiological finding of distinctive hypertrophic change around the pars defect, which occurred in a young professional football player.
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Incidence and etiology of lumbar Spondylolysis: review of the literature
Journal of Orthopaedic Science, 2010Co-Authors: Toshinori Sakai, Koichi Sairyo, Naoto Suzue, Hirofumi Kosaka, Natsuo YasuiAbstract:Background Lumbar Spondylolysis is a defect of the pars interarticularis known to occur as a stress fracture. Its incidence varies considerably depending on ethnicity, sex, and sports activity. However, there are few literature reviews describing its incidence in different ethnic groups or in people who engage in different sports. Methods We reviewed the most relevant articles on Spondylolysis published in scientific journals. First, we focused on its incidence in various ethnic groups distributed by sex, the familial occurrence, and in patients with relevant diseases. Second, we focused on the incidence of Spondylolysis in relation to the sports practiced by the patients. Although placing special emphasis on the incidence of lumbar Spondylolysis in the general population in Japan, we also reviewed the Japanese and English literature to investigate its incidence among those who engage in different sports. Results The incidence of lumbar Spondylolysis in the general Japanese population was 5.9%. Most studies report that the incidence in higher in male subjects than in female subjects. We found that Japanese rugby and judo players were prone to suffer lumbar Spondylolysis, at an incidence of about 20%. However, the incidence for Japanese professional soccer and baseball players was much higher, at 30%, which was more than five times the incidence in the general Japanese population. Conclusions The incidence of lumbar Spondylolysis varies depending on ethnicity, sex, family history, relevant disease, and sports activity.
Victor X D Yang - One of the best experts on this subject based on the ideXlab platform.
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multilevel Spondylolysis repair using the smiley face technique with 3 dimensional intraoperative spinal navigation
World Neurosurgery, 2018Co-Authors: Mathew R Voisin, Christopher D Witiw, Ryan Deorajh, Daipayan Guha, Adetunji Oremakinde, Shelly Wang, Victor X D YangAbstract:Background/Objective Multilevel Spondylolysis is a rare cause of progressive lower back pain, and patients who fail conservative management are treated surgically. Direct repair methods can maintain mobility and lead to decreased morbidity compared with spinal fusion in single-level Spondylolysis. In this paper, we present a patient with nonadjacent multilevel Spondylolysis who underwent the “smiley face” technique of direct multilevel repair without fusion using 3-dimensional intraoperative spinal navigation. Methods Bilateral Spondylolysis at L3 and L5 with associated spondylolisthesis in a 50-year-old male was repaired using the “smiley face” technique. Patient-reported outcomes, including the Oswestry Disability Index (ODI) and visual analog scale scores for back and leg pain, were assessed preoperatively along with 6 weeks and 4 months postoperatively. Results Postoperative computed tomography imaging showed precise screw insertion and rod placement along with stable hardware alignment in follow-up imaging. The patient's ODI and lower back visual analog scale scores decreased from 25 to 8 and 7.5 to 4, respectively, correlating to an excellent outcome on ODI. Conclusion Direct repair and avoidance of fusion is possible and can provide good functional outcomes in patients with nonadjacent multilevel Spondylolysis and associated spondylolisthesis.
Toshinori Sakai - One of the best experts on this subject based on the ideXlab platform.
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Degenerative Changes of the Facet Joints in Adults With Lumbar Spondylolysis.
Journal of Spinal Disorders & Techniques, 2020Co-Authors: Yuichiro Goda, Toshinori Sakai, Shoichiro Takao, Taihei Harada, Yoichiro Takata, Kosaku Higashino, Masafumi Harada, Koichi SairyoAbstract:STUDY DESIGN: Radiologic analysis using computed tomography. OBJECTIVES: To analyze the degenerative changes of the facet joints in patients with Spondylolysis in comparison with control subjects. SUMMARY OF BACKGROUND DATA: Defects of the pars interarticularis are thought to result in a reduction of biomechanical stress on adjacent facet joints. Therefore, degenerative changes of the facet joints in patients with Spondylolysis are expected to be less than those in patients without Spondylolysis. METHODS: Abdominal and pelvic multidetector computed tomography scans of 2000 subjects, performed for conditions unrelated to low back pain, were reviewed. A total of 107 patients (37 women and 70 men) with L5 Spondylolysis were identified [Spondylolysis (+) group]. Sex-matched and age-matched controls without Spondylolysis were chosen randomly [Spondylolysis (-) group]. Subjects in the Spondylolysis group were subdivided into either bilateral Spondylolysis or unilateral Spondylolysis groups for comparison with the control group. Four radiologic findings (narrowing, sclerosis, osteophyte, and bone cyst) indicative of degenerative change of the facet joints adjacent to the L5 pars defects were evaluated and the degree of degenerative change was graded by summing the number of degenerative changes (score range, 0-4). The χ test and Mann-Whitney U test were used for statistical analysis. RESULTS: Significantly more degenerative changes in both L4/L5 and L5/S facet joints were found in the Spondylolysis (+) group than in the Spondylolysis (-) group (χ test, P
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prevalence of symptomatic lumbar Spondylolysis in pediatric patients
Orthopedics, 2016Co-Authors: Akihiro Nitta, Toshinori Sakai, Yuichiro Goda, Yoichiro Takata, Kosaku Higashino, Tadanori Sakamaki, Koichi SairyoAbstract:: Lumbar Spondylolysis, a stress fracture of the pars interarticularis, is prevalent in adolescent athletes. Recent advances in diagnostic tools and techniques enable early diagnosis before these fractures progress to complete fractures through the pars. However, because patients often consult family physicians for primary care of low back pain and these physicians may not have access to diagnostic modalities such as magnetic resonance imaging (MRI) and computed tomography, stress fractures can be missed. This study surveyed the prevalence of symptomatic Spondylolysis in pediatric patients who consulted an orthopedic clinic for primary care and investigated whether such acute stress fractures may be overlooked without MRI. The prospective study investigated 264 patients who were younger than 19 years and had low back pain. Of the 153 patients (58.0%) with low back pain persisting for longer than 2 weeks, 136 who agreed to undergo MRI were included in the study. This group included 11 elementary school students, 71 junior high school students, and 54 high school students. The overall prevalence of lumbar Spondylolysis was 39.7% (54 of 136) and was 9.3% in elementary school students (5 of 11, 45.5%), 59.3% in junior high school students (32 of 71, 45.1%), and 31.5% in high school students (17 of 54, 31.5%). All 54 patients with Spondylolysis had a history of athletic activity. Primary care physicians should recognize that approximately 40% of pediatric patients presenting with low back pain persisting for longer than 2 weeks may have Spondylolysis and should consider MRI in those with a history of athletic activity. Because the spine is immature in this age group, almost half of affected elementary school and junior high school students may have lumbar Spondylolysis. [Orthopedics. 2016; 39(3):e434-e437.].
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analysis of mri signal changes in the adjacent pedicle of adolescent patients with fresh lumbar Spondylolysis
European Spine Journal, 2014Co-Authors: Yuichiro Goda, Toshinori Sakai, Yoichiro Takata, Kosaku Higashino, Tadanori Sakamaki, Koichi SairyoAbstract:Purpose The purpose of this study is to investigate a discrepancy between MRI and computed tomography (CT) findings in the spinal level distribution of Spondylolysis. Recent advances in MRI have led to the early diagnosis of Spondylolysis. Therefore, bony healing can be expected before the condition has a chance to worsen. In this study, we used MRI to examine the changes in spinal level signals in the pedicles adjacent to the pars interarticularis in adolescents with fresh lumbar Spondylolysis. We then compared spinal level distribution of Spondylolysis with that of previous results obtained by multidetector CT.
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A remarkable case of hypertrophic pseudoarthrosis of the pars interarticularis in a young American football professional player
European Journal of Orthopaedic Surgery & Traumatology, 2012Co-Authors: Ryo Miyagi, Koichi Sairyo, Toshinori Sakai, Akira DezawaAbstract:Lumbar Spondylolysis is a defect of the pars interarticularis regarded as a stress fracture. The bone stump around the pars defect usually appears atrophic and is fibrously united or filled with fibro cartilaginous mass, similar to long bone pseudoarthrosis. Lumbar Spondylolysis sometimes causes bone growth resembling that of an osteophyte in osteoarthritis, and in elderly patients, the ragged edges result in radiculopathy around the defect. However, lumbar Spondylolysis is rarely reported to cause hypertrophic changes resulting in spinal canal stenosis in young patients. In this report, we present an unprecedented radiological finding of distinctive hypertrophic change around the pars defect, which occurred in a young professional football player.
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Incidence and etiology of lumbar Spondylolysis: review of the literature
Journal of Orthopaedic Science, 2010Co-Authors: Toshinori Sakai, Koichi Sairyo, Naoto Suzue, Hirofumi Kosaka, Natsuo YasuiAbstract:Background Lumbar Spondylolysis is a defect of the pars interarticularis known to occur as a stress fracture. Its incidence varies considerably depending on ethnicity, sex, and sports activity. However, there are few literature reviews describing its incidence in different ethnic groups or in people who engage in different sports. Methods We reviewed the most relevant articles on Spondylolysis published in scientific journals. First, we focused on its incidence in various ethnic groups distributed by sex, the familial occurrence, and in patients with relevant diseases. Second, we focused on the incidence of Spondylolysis in relation to the sports practiced by the patients. Although placing special emphasis on the incidence of lumbar Spondylolysis in the general population in Japan, we also reviewed the Japanese and English literature to investigate its incidence among those who engage in different sports. Results The incidence of lumbar Spondylolysis in the general Japanese population was 5.9%. Most studies report that the incidence in higher in male subjects than in female subjects. We found that Japanese rugby and judo players were prone to suffer lumbar Spondylolysis, at an incidence of about 20%. However, the incidence for Japanese professional soccer and baseball players was much higher, at 30%, which was more than five times the incidence in the general Japanese population. Conclusions The incidence of lumbar Spondylolysis varies depending on ethnicity, sex, family history, relevant disease, and sports activity.
Patrick J Johnson - One of the best experts on this subject based on the ideXlab platform.
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direct surgical repair of Spondylolysis in athletes indications techniques and outcomes
Neurosurgical Focus, 2011Co-Authors: Doniel Drazin, Ali Shirzadi, Sunil Jeswani, Harry Ching, Jack Rosner, Alexandre Rasouli, Robert Pashman, Patrick J JohnsonAbstract:Object Athletes present with back pain as a common symptom. Various sports involve repetitive hyperextension of the spine along with axial loading and appear to predispose athletes to the spinal pathology Spondylolysis. Many athletes with acute back pain require nonsurgical treatment methods; however, persistent recurrent back pain may indicate degenerative disc disease or Spondylolysis. Young athletes have a greater incidence of Spondylolysis. Surgical solutions are many, and yet there are relatively few data in the literature on both the techniques and outcomes of spondylolytic repair in athletes. In this study, the authors undertook a review of the surgical techniques and outcomes in the treatment of symptomatic Spondylolysis in athletes. Methods A systematic review of the MEDLINE and PubMed databases was performed using the following key words to identify articles published between 1950 and 2011: “Spondylolysis,” “pars fracture,” “repair,” “athlete,” and/or “sport.” Papers on both athletes and nonathl...
Leonid Kalichman - One of the best experts on this subject based on the ideXlab platform.
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geometry of the vertebral bodies and the intervertebral discs in lumbar segments adjacent to Spondylolysis and spondylolisthesis pilot study
European Spine Journal, 2011Co-Authors: Ella Been, David J Hunter, Ling Li, Leonid KalichmanAbstract:The objective is to evaluate the geometric parameters of vertebral bodies and intervertebral discs in spinal segments adjacent to Spondylolysis and spondylolisthesis. This pilot cross-sectional study was an ancillary project to the Framingham Heart Study. The presence of Spondylolysis and spondylolisthesis as well as measurements of spinal geometry were identified on CT imaging of 188 individuals. Spinal geometry measurements included lordosis angle, wedging of each lumbar vertebra and intervertebral disc. Last measurements were used to calculate ΣB, the sum of the lumbar L1–L5 body wedge angles; and ΣD, the sum of the lumbar L1–L5 intervertebral disc angles. Using Wilcoxon–Mann–Whitney test we compared the geometric parameters between individuals with no pathology and ones with Spondylolysis (with no listhesis) at L5 vertebra, ones with isthmic spondylolisthesis at L5–S1 level, and ones with degenerative spondylolisthesis at L5–S1 level. Spinal geometry in individuals with Spondylolysis or listhesis at L5 shows three major patterns: In Spondylolysis without listhesis, spinal morphology is similar to that of healthy individuals; In isthmic spondylolisthesis there is high lordosis angle, high L5 vertebral body wedging and very high L4–5 disc wedging; In degenerative spondylolisthesis, spinal morphology shows more lordotic wedging of the L5 vertebral body, and less lordotic wedging of intervertebral discs. In conclusion, there are unique geometrical features of the vertebrae and discs in Spondylolysis or listhesis. These findings need to be reproduced in larger scale study.
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facet orientation and tropism associations with Spondylolysis
Journal of Spinal Disorders & Techniques, 2010Co-Authors: Leonid Kalichman, Ali Guermazi, Ling Li, David J Hunter, Pradeep SuriAbstract:STUDY DESIGN: Cross-sectional study. OBJECTIVE: To evaluate the association between lumbar spine facet joint orientation, facet joint tropism, and Spondylolysis identified by multidetector computed tomography (CT) in the community-based Framingham Heart Study. SUMMARY OF BACKGROUND DATA: The association between lumbar Spondylolysis and facet orientation and tropism remains unclear. METHODS: This study was an ancillary project to the Framingham Heart Study. Three thousand five hundred twenty-nine participants of the Framingham Heart Study aged 40 to 80 years underwent multidetector CT imaging to assess aortic calcification. One hundred ninety-one subjects were included in this ancillary study. Facet joint features and Spondylolysis were evaluated on CT scans. The final analyzed sample included 104 men with mean age 51.90+/-11.25 years and 84 women with mean age 53.61+/-10.20 years. The association between Spondylolysis and facet orientation and tropism was examined using univariate and multivariate analyses. RESULTS: Spondylolysis was prevalent in 11.5% of the total population. chi2 test demonstrated a significant sex difference in prevalence of Spondylolysis (P=0.0154), with almost 3 times higher prevalence among men. There was no statistically significant difference in facet orientation and continuous facet tropism between individuals with and without Spondylolysis at the L5 level (P=0.49 to 0.91). After adjustment for age, sex, and body mass index, no significant association between the occurrence of Spondylolysis and facet orientation and tropism was found. In the studied sample the prevalence of facet joint osteoarthritis was significantly higher in individuals with Spondylolysis than in those without Spondylolysis at both sides of L4-L5 spinal level (P=0.044 at the right side and P=0.003 at the left side) and at left side of L5-S1 level (P=0.038). CONCLUSIONS: We did not find an association between facet orientation, facet tropism, and Spondylolysis. One of the possible explanations for this is that the high prevalence of facet joint osteoarthritis in individuals with Spondylolysis in the studied sample might have led to diminished differences in facet orientation.
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Spondylolysis and spondylolisthesis prevalence and association with low back pain in the adult community based population
Spine, 2009Co-Authors: Leonid Kalichman, Ali Guermazi, Ling Li, Valery Berkin, David J HunterAbstract:STUDY DESIGN: Cross-sectional study. OBJECTIVES: To determine prevalence rates of Spondylolysis, isthmic, and degenerative spondylolisthesis in an unselected adult community-based population; and to evaluate the association of Spondylolysis, isthmic, and degenerative spondylolisthesis with low back pain (LBP). SUMMARY OF BACKGROUND DATA: Spondylolysis and spondylolisthesis are prevalent in the general population; however, the relationship between these conditions and LBP is controversial. METHODS: This study was an ancillary project to the Framingham Heart Study. A sample of 3529 participants of the Framingham Heart Study aged 40 to 80 years underwent multidetector CT imaging to assess aortic calcification. One hundred eighty-eight individuals were consecutively enrolled in this study to assess radiographic features potentially associated with LBP. The occurrence of LBP in the preceding 12 months was evaluated using a self-report questionnaire. The presence of Spondylolysis and spondylolisthesis was characterized by CT imaging. We used multiple logistic regression models to examine the association between Spondylolysis, spondylolisthesis, and LBP, while adjusting for gender, age, and BMI. RESULTS: Twenty-one study subjects demonstrated Spondylolysis on computed tomography (CT) imaging. The male-to-female ratio was approximately 3:1. Twenty-one percent of subjects with bilateral spondylolytic defects demonstrated no measurable spondylolisthesis. The male-to-female ratio of degenerative spondylolisthesis was 1:3, and the prevalence of degenerative spondylolisthesis increased from the fifth through 8 decades of life. Thirty-eight subjects (20.4%) reported significant LBP. No significant association was identified between Spondylolysis, isthmic spondylolisthesis, or degenerative spondylolisthesis, and the occurrence of LBP. CONCLUSION: Based on CT imaging of an unselected community-based population, the prevalence of lumbar Spondylolysis is 11.5%, nearly twice the prevalence of previous plain radiograph-based studies. This study did not reveal a significant association between the observation of Spondylolysis on CT and the occurrence of LBP, suggesting that the condition does not seem to represent a major cause of LBP in the general population.
