Masaki Tatsumura1, Hisanori Gamada2, Shun Okuwaki2, Fumihiko Eto3, Katsuya Nagashima3, Takeshi Ogawa3, Takeo Mammoto3, Atsushi Hirano3, Masao Koda2, Masashi Yamazaki2. 1. Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, 3-2-7 Miyamachi, 310-0015, Mito, Ibaraki, Japan. tatsumura@md.tsukuba.ac.jp. 2. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 3. Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, 3-2-7 Miyamachi, 310-0015, Mito, Ibaraki, Japan.
Abstract
BACKGROUND: If bone union is expected, conservative treatment is generally selected for lumbar spondylolysis. However, sometimes conservative treatments are unsuccessful. We sought to determine the factors associated with failure of bony union in acute unilateral lumbar spondylolysis with bone marrow edema including contralateral pseudarthrosis. METHODS: This study targeted unilateral lumbar spondylolysis treated conservatively in high school or younger students. Conservative therapy was continued until the bone marrow edema disappeared on MRI and bone union was investigated by CT. We conducted a univariate analysis of sex, age, pathological stage, lesion level complicating the contralateral bone defect, lesion level, and intercurrent spina bifida occulta, and variables with p < 0.1 were considered in a logistic regression analysis. An item with p < 0.05 was defined as a factor associated with failure of bony union. RESULTS: We found 92 cases of unilateral spondylolysis with bone marrow edema and 66 cases were successfully treated conservatively. Failure of bony union in unilateral lumbar spondylolysis with bone marrow edema was associated with progressive pathological stage (p = 0.004), contralateral pseudarthrosis (p < 0.001), and L5 lesion level (p = 0.002). The odds ratio was 20.0 (95% CI 3.0-193.9) for progressive pathological stage, 78.8 (95% CI 13-846) for contralateral pseudarthrosis, and 175 (95% CI 8.5-8192) for L5 lesion level. CONCLUSIONS: Conservative therapy aiming at bony union is contraindicated in cases of acute unilateral spondylolysis when the pathological stage is progressive, the lesion level is L5, or there is contralateral pseudarthrotic spondylolysis.
BACKGROUND: If bone union is expected, conservative treatment is generally selected for lumbar spondylolysis. However, sometimes conservative treatments are unsuccessful. We sought to determine the factors associated with failure of bony union in acute unilateral lumbar spondylolysis with bone marrow edema including contralateral pseudarthrosis. METHODS: This study targeted unilateral lumbar spondylolysis treated conservatively in high school or younger students. Conservative therapy was continued until the bone marrow edema disappeared on MRI and bone union was investigated by CT. We conducted a univariate analysis of sex, age, pathological stage, lesion level complicating the contralateral bone defect, lesion level, and intercurrent spina bifida occulta, and variables with p < 0.1 were considered in a logistic regression analysis. An item with p < 0.05 was defined as a factor associated with failure of bony union. RESULTS: We found 92 cases of unilateral spondylolysis with bone marrow edema and 66 cases were successfully treated conservatively. Failure of bony union in unilateral lumbar spondylolysis with bone marrow edema was associated with progressive pathological stage (p = 0.004), contralateral pseudarthrosis (p < 0.001), and L5 lesion level (p = 0.002). The odds ratio was 20.0 (95% CI 3.0-193.9) for progressive pathological stage, 78.8 (95% CI 13-846) for contralateral pseudarthrosis, and 175 (95% CI 8.5-8192) for L5 lesion level. CONCLUSIONS: Conservative therapy aiming at bony union is contraindicated in cases of acute unilateral spondylolysis when the pathological stage is progressive, the lesion level is L5, or there is contralateral pseudarthrotic spondylolysis.
Entities:
Keywords:
Contralateral pseudarthrosis lesion; Lumbar spondylolysis; Treatment failure and risk factor; Union inhibitor
Authors: Conal Quah; Mark S Yeoman; Andrius Cizinauskas; Kevin C Cooper; Nick S Peirce; Donal S McNally; Bronek M Boszczyk Journal: Spine J Date: 2013-11-21 Impact factor: 4.166