7% of adolescent idiopathic scoliosis (AIS) patients also present with a pars defect. To date, there are no available data on the results of fusion ending proximal to a spondylolysis in the setting of AIS. The aim of this study was to analyze the outcomes of posterior spinal fusion (PSF) in this patient cohort, to investigate if maintaining the lytic segment unfused represents a safe option. Retrospective review of all patients who received PSF for AIS, presented with a spondylolysis or spondylolisthesis and had a min. 2-years follow-up. Demographic data, instrumented levels and preoperative radiographic data were collected. Mechanical complications, coronal or sagittal parameters, amount of slippage and pain levels were evaluated. Data from 22 patients were available (age 14.4 ± 2.5 years), 18 Lenke 1–2 and four Lenke 3–6. Five patients (24%) had an isthmic spondylolisthesis, all Meyerding I. The mean preoperative Cobb angle of the instrumented curves was 58 ± 13°. For 18 patients the lowest instrumented vertebra (LIV) was the last touched vertebra (LTV); for two LIV was distal to the LTV; for two, LIV was one level proximal to the LTV. The number of segments between the LIV and the lytic vertebra ranged from 1 to 6. At the last follow-up, no complications were observed. The residual curve below the instrumentation measured 8.5 ± 6.4°, the lordosis below the instrumented levels was 51.4 ± 13°. The magnitude of the isthmic spondylolisthesis remained constant for all included patients. Three patients reported minimal occasional low back pain. The LTV can be safely used as LIV when performing PSF for the management of AIS in patients with L5 spondylolysis

Background: The simultaneous occurrence of spina bifida occulta (SBO) and spondylolysis has been noted previously. The occurrence of SBO and spondylolysis are approximately 17% and 5% respectively. Aims: The aim of this study was to determine the incidence of SBO when a symptomatic spondylolysis has been proven. Method: Analysis of four years of lumbar spine CT scans was performed. Patients with spondylolysis or spondylolisthesis caused by a pars defect were identified. These patients’ CT images were then reviewed to establish the patients who also had SBO. Results: In this unit 650 CT scans of lumbar spines were performed in the last five years. Of these scans 100 (15%) were found to have a pars defect. The average age was 34.6. On CT 30 (30%) patients were shown to have SBO. Of the total 23 were under 18 years old and 13 (56%) of these patients had SBO associated with the spondylolysis. In the over 18 year olds 21 (27%) patients had SBO associated with spondylolysis. On review of the 550 other scans the average age was 51.9 years old. The incidence of SBO within this group is 10%. Only 6% of these patients were under 18. Out of these 33 patients 30.3% (10 patients) had SBO. Over 18 the incidence of SBO was only 8.5%. Conclusions: Our results indicate that the occurrence of SBO within the group with a spondylolysis is much higher than in the group where no spondylolysis is present. There is higher incidence of SBO in the younger patients with spondylolysis. 56% of paediatric patients with symptomatic spondylolysis will have SBO. Clinicians should be aware of this fact preoperatively to decide on the technique of repair of the symptomatic lysis

There is conflicting information regarding the recommendations of bracing, physical therapy and cessation of sports for young athletes with symptomatic spondylolysis. The purpose of this study was to identify factors affecting the prognosis and to find the optimal method of non-operative treatment. The patients in our study were athletes who visited our children's hospital for low back pain with lumbar spondylolysis and were treated non-operatively from 1990 to 2002. Clinical and radiological outcomes were reviewed retrospectively. The effects of bracing, physical therapy, cessation of sports, duration of symptoms before the first hospital visit, lateralisation of spondylolysis, age, gender, onset of low back pain after lumbar trauma during sports, bone scan uptake, vertebral level of the lesion, associated scoliosis or spina bifida and radiological bony healing were analysed using univariate and multivariate analysis with logistic regression. The mean age of patients was 13 years (range 7 to 18 years). The mean follow-up was 4.2 years (range 1.2 to 12 years). Of 132 patients, 48 patients had excellent results with no pain during sports, 76 good, 6 fair, and 4 poor. Cessation of sports, early non-operative intervention, and a unilateral spondylolysis appeared to be factors associated with excellent outcomes. However, bracing, physical therapy, age, gender, level of lesion, history of trauma, increased uptake on bone scan, or associated scoliosis or spina bifida were not factors. Bony healing was not related to the clinical outcome. The non-operative treatment of spondylolysis in children can yield excellent clinical outcomes, and the absence of bony healing has no influence on clinical outcome. Factors in this study found to correlate with an excellent outcome include unilateral spondylolysis, acute spondylolysis, and treatment with cessation of sports for 12 weeks

This study using digitized radiographs and custom software demonstrates that patients with spondylolysis and low-grade spondylolisthesis have increased Pelvic and L5 Incidence as well as a more vertically oriented L5-S1 intervertebral disc than patients without radiographic abnormality of the spine. We propose that shear across the more vertical L5-S1 disc may underlie the etiology of spondylolysis when Pelvic Incidence is high, while a “nutcracker” mechanism may be involved when Pelvic Incidence is low. The purpose of this study was to assess whether differences exist in sagittal alignment between normal controls and patients with spondylolysis or low-grade isthmic spondylolisthesis. Standing PA and lateral spine radiographs from eighty-two consecutive patients with spondylolysis or low-grade spondylolisthesis (Average age nineteen, range 15–44) were retrospectively compared with those from one hundred and sixty normal volunteers. The films were digitized with a VIDAR scanner and key landmarks were determined. Customized software was then used to measure geometric indices. Pelvic Incidence (PI), Sacral Slope (SS), Pelvic Tilt (PT), and L5-S1extension angle were compared between seventy-two patients with high PI (> 45°) versus ten patients with low PI (< 45°). Average high-PI vs. low-PI values were, respectively: PI (67.32° vs. 43.13°), SS (51.08° vs. 38.05°), PT (16.23° vs. 5.08°), and L5-S1ext (−8.69° vs. −9.57°). Furthermore, the range of values for L5-S1extension in the low-PI subgroup was much narrower (−17.81° to 0.93°) than that for the high-PI subgroup (−31.58° to 38.12°). This study demonstrates that patients with spondylolysis and low-grade spondylolisthesis have increased Pelvic and L5 incidence, a more vertically oriented L5-S1 intervertebral disc, and less segmental extension between L5 and S1 than patients without radiographic abnormality of the spine. We propose that different mechanisms underlie the etiology of spondylolysis depending on the magnitude of the Pelvic Incidence. These data highlight the importance of seeing localized lumbosacral spine disorders in the context of global alignment of the entire spine and pelvis. Funding: This research was assisted by support from the Spinal Deformity Study Group. This research was funded by an educational/research grant from Medtronic Sofamor Danek

We report a prospective case-series study to evaluate the results of non-operative and operative treatment of symptomatic unilateral lumbar spondylolysis. Non-operative treatment results in healing in most patients with symptomatic unilateral spondylolysis. Surgery however is indicated when symptoms persist beyond a reasonable time affecting the quality of life in young patients particularly the athletic population. We treated 41 patients [31 male, 10 female] with suspected unilateral lumbar spondylolysis. Thirty-one patients were actively involved in sports at various levels. Patients with a positive stress reaction on SPECT imaging underwent a strict protocol of activity restriction, bracing and physical therapy for 6 months. At the end of six months, patients who remained symptomatic underwent a Computed Tomography [CT] scan to confirm the persistence of a spondylolysis. Seven patients subsequently underwent a direct repair of the defect using the modified Buck's Technique. Baseline Oswestry disability index [ODI] and Short-Form-36 [SF-36] scores were compared to two year ODI and SF-36 scores for all patients. In the non-operated group, the mean pre-treatment ODI was 36 [SD=10.5], improving to 6.2 [SD=8.2] at two years. In SF-36 scores, the physical component of health [PCS] improved from 30.7 [SD=3.2] to 53.5 [SD =6.5] [p<0.001], and the mean score for the mental component of health [MCS] improved from 39 [SD=4.1] to56.5 [SD=3.9] [p<0.001] at two years. 20/31 patients resumed their sporting career within 6 months of onset of treatment, a further 4/31 patients returned to sports within one year. The seven patients who remained symptomatic at six months underwent a unilateral modified Buck's Repair. The most common level of repair was L5 (n=4). The mean pre-operative ODI was 39.4 (SD=3.6) improving to 4.4 (SD=4) at the latest follow-up. The mean score of PCS [SF-36] improved from 29.6 [SD=4.4] to 51.2 [SD=5.2] (SD=5.2) (p<0.001) and the mean score of MCS (SF-36) improved from 38.7 (SD=1.9) to 55.5 (SD=5.4) (p<0.001). A specific protocol of conservative treatment for patients with a unilateral lumbar spondylolysis resulted in a high rate of success with 83% of patients avoiding surgery. If symptoms persist beyond a reasonable period (i.e. 6 months) and reverse gantry CT scan confirms a non-healing defect of the pars interarticularis one may consider a unilateral direct repair of the defect with good outcome ultimately

Study Design: The lumbar spine of children an adolescents with suspected spondylolysis was assessed by magneting resonance imaging. Objectives: To evaluate the value of MRI in diagnosis and after nonoperative treatment of incipient spondylolysis in children and adolescents. Summary of Background Data: The diagnosis of incipient spondylolysis in children and adolescents is difficult. Radiographs have a low sensitivity and the use of bone scans, computer tomography and MRI controversial. Methods: The study is prospective. The lumbar spine was assessed by MR imaging in children (n=14, mean age 12.4 years) with unspecific low back pain for more than 3 weeks and normal plain radiographs at presentation. Six of the seven children were involved in moderate to severe sport activities. Incipient spondylolysis was diagnosed when on T1 sequences a hypointense area was found within the pars interarticularis of any lumbar vertebra while on T2 sequences a corresponding hyperintense zone was detected. Brace and activity restriction was recommended. Follow-up MRI studies were performed after treatment at 3 months interval. Results: Seven of 14 patients presented with pars edema (T1 hypointense, T2 hyperintense), six at L5 vertebra, one at L4 and L5 vertebra, respectively. After 3 months healing was demonstrated both clinically and by imaging in six children in another child healing was observed after 6 months. Conclusions: MRI showed promising results in detecting and monitoring the early onset of spondylolysis. In our cases early treatment prevented pars defects

Introduction. The incidence of spondylolysis is estimated about 5–6% in the general population and accounts for one of the most frequent cause of backpain in the adolescent. The purpose of this study is to present our results from the management of these patients. Patients and Methods. During the period 1993–2003, 25 children with spondylolysis and spondylolisthesis were managed in our department. Apart from radiographic studies, in cases with a history of acute trauma, a bone scan as well as a CT or MRI scan were performed. There were 13 male and 12 female patients with a mean age of 10.5 years (5–14 years). There were 15 cases of spondylolysis, one at L3 level, 3 at L4 and 11 at L5. 10 patients had spondylolisthesis, 8 of the isthmic type and 2 of the dysplastic type. THe mean follow up of the patients was 6.5 years. Results. In 24 cases the management was conservative with bedrest until the symproms subsided. Following symptoms resolution a brace was fitted, depending on the case, for 3–6 months. In one case of Grade II spondylolisthesis with nerve root irritation a posterolateral arthrodesis according to Wiltse was performed, following failure of a prolonged period of conservative management. The results of our patients were evaluated clinically and radiologically according to Seitsalo et al and they were in all cases excellent or good, with full return of the affected children to their previous activities. Conclusion. In conlusion, spondylolysis and spondylolisthesis is managed conservative in children with good results. Rarely in cases were the symptoms persist despite conservative management, surgical treatment can provide a good result

This paper describes our experience about isthmic reconstruction on younger children. Study design: we carried out 9 operations, the average age was 10 and a half, with bilateral spondylolysis at L5 and persistent disabling symptomatology. All had signs of dysplasia in the lumbar spine. Method: We used the Buck technique. Results: The follow-up was after 3 years. In all cases we checked if consolidation had occurred without complications. We found all the symptomatology had disappeared and patients were thus free of back pain. We did not find any slippage of vertebra L5 after reconstruction, albeit we have not had a long enough follow-up since the children treated have not yet reached adult status. Discussion: According to Wiltse there are 5 types of isthmic lysis. Types 1 and 2 are mainly found in young people and are often confused. Type 1 is a dysplasia often found also in type 2 which instead involves isthmic spondylolysis. Therefore we prefer to speak of isthmic dysplastic spondylolysis and isthmic lithic spondylolysis when referring to children. Conclusions: Is preferable to carry out a reconstruction at an earlier stage to prevent the slippage, as well as the risk of arthrodesis later on

Objective: To assess the clinical outcome and return to sport following surgical treatment of spondylolysis in young sporting individuals. Design: A prospective outcome analysis of consecutive surgically treated cases of lumbar spondylolysis in young sporting individuals. Subjects: Twenty-two young sports persons (15M: 7F) with a mean age of 20.2 years (range 15–34 years) were surgically treated for radiographically confirmed spondylolysis between 1994 and 1999. Eleven patients were professional footballers and four were professional cricketers. Pre operative assessment included plain X-rays, SPECT imaging with planar bone scan and reverse gantry CT scans. All subjects had pre-operative Oswestry Disability Index (ODI) and SF36 scores recorded. Eighteen patients underwent Buck’s fusion and four patients underwent Scott’s fusion. A graduated exercise regime was commenced at 12 weeks. At two year follow-up nineteen patients had ODI and SF36 scores recorded. Outcome Measures: The clinical outcome in individual patients supported by statistical analysis of the pre operative and post-operative data was performed using SPSS (ver 10). Return to the sporting activity at the previous level was regarded as a successful outcome. Results: Eleven patients had bilateral spondylolysis at L5. Twenty patients had positive uptake on SPECT imaging and the remaining two were diagnosed to have lysis on CT scans alone. The average duration of back pain before the patients underwent surgery were 8.4 months (range 3–36 months). The mean lysis defect determined by CT was 3.5 mm (range 1–8 mm). The mean pre-operative and post-operative ODIs were 40.5 and 12.4 respectively (SEpreop = 2.06 and SEpostop = 3.05). The mean scores of physical health component of SF36 improved from 27.1 to 47.8 (SEmean = 1.1 and 1.7 respectively). The mean scores of mental health component of SF36 improved from 39.1 to 55.3 (SEmean = 0.9 and 1.4 respectively) [P < 0.001]. Eighteen patients returned to their previous active sporting career following an average of seven months of rehabilitation (range 4–10 months). Conclusions: The surgical repair of bilateral spondylolysis with Buck’s fusion in professional sportsmen and women results in a significant improvement in Oswestry Disability scores (P< . 001) and in all domains of SF36 health questionnaire (P< . 001). 90% return to active sport seven months following surgery

This is a retrospective study of patient out-come after spondylolytic repair using a Scott¦s or a Van Dam Procedure (tension band repair). We also looked at the use of plain static radiographs, and a reverse gantry computed tomography scanning in the assessment of healing of the spondylolytic defect. Tension band repair of spondylolysis has proved to be a useful procedure for refractory spondylolysis. However, there is no universally accepted method or determining fusion of the spondylolysis, and the definitive criteria for diagnosing a successful fusion remains controversial. The Oswestry Disability Index was measured in 2000 and in 2004. Plain static radiographs and computed tomography scans were performed on 14 patients one year after fixation of the spondylolysis. A radiologist and an independent orthopaedic surgeon assessed the presence of bridging trabecular bone in the scan and X rays. Results in 14 patients were rated as excellent and in 4 as good in year 2000 and results remained excellent to good in 16 of 17 patients followed up in year 2004. The fusion rate was 90%[18/20] on the plain radiographs. Fusion on the computed tomography scans was observed in 50% [7/14]. A high rate of good-excellent clinical results can be obtained following a Scott or Van Dam Procedure. Radiological fusion rate was higher than assessment with thin-section computed tomography scans. CT tomography studies clearly demonstrated the presence or absence of bridging bone, a property not easy to see in plain static radiographs. However, clinical significance of CT non-union is not clear

The incidence of symptomatic pars defect varies between 15% and 47% in the young athletic population. We have analysed the outcome of direct repair spondylolysis on young professional athletes. We have prospectively studied 22 young athletes with lumbar spondylolysis in whom conservative treatment has failed. Fifteen male and 7 female patients with a mean age of 20.2 years (range 15–34 years) were surgically treated for radiographically confirmed spondylolysis between 1994 and 1999. Eleven patients were professional footballers and four were professional cricketers. Pre-operative assessment included plain X rays, SPECT imaging with planar bone scan and reverse gantry CT scans. All patients had the Oswestry disability index (ODI) and 19 patients had Short Form 36 (SF-36) scores recorded pre-operatively and two years post operatively. Nineteen patients underwent Buck’s fusion and 3 underwent Scott’s fusion. At two-year follow-up nineteen patients had ODI and SF36 scores recorded. Return to the sporting activity at the previous level was regarded as a successful outcome. The average duration of back pain prior to surgery was 8.9 months (range 1-36 months). The mean lysis defect determined by CT was 3.5 mm (range 1–8 mm). The mean pre-operative ODI was 39.5 (SD=8.7) and the mean post-operative ODI was 10.7 (SD=12.9). The mean scores of the physical health component of SF-36 improved from 27.1 (SD=5.1) to 47.8 (SD=7.7). The mean scores of the mental health component of SF-36 improved from 39.0 (SD=3.9) to 55.4 (SD=6.3) [P < 0.001]. The surgical repair of bilateral spondylolysis with modified Buck’s fusion in professional sportsmen and women results in a significant improvement in Oswestry Disability scores (p< 0.001) and in all domains of SF36 health questionnaire (p< 0.001). Ninety five percent of patients in this group return to active sport within seven months of surgery

Introduction: Age related histological and radiological changes are widespread in the lumbar spine. The correlation with symptoms is poor and there is good evidence that in later decades the incidence of back symptoms decreases, despite the relentless progression of radiological abnormalities. Much confusion exists regarding Accident Compensation Corporation (ACC) insurance entitlement following injuries in the presence of asymptomatic but existing radiological ageing changes (spondylosis) and existing but asymptomatic spondylolysis/isthmic spondylolisthesis. Aim: To review the relevant literature and ACC Acts to clarify the ACC Act definition of injury/accident and exclusion criteria and the natural history of spondylosis/spondylolysis/spondylolisthesis, in relation to patients sustaining new lumbar spine injuries in the presence of existing but asymptomatic radiological abnormalities. Method: The relevant literature and legislation (1992 ARCI and 1998 AI Acts) were reviewed. Results: Regarding spondylolysis and low grade isthmic spondylolisthesis the literature is conflicting in relation to the incidence of back symptoms. The ACC Acts do not discuss existing disorders or degenerative conditions, but focus on exclusion of cover for ‘personal injury caused wholly or substantially by the ageing process’. Conclusions: As with clinical decision making medico-legal assessment requires a meticulous history as the primary focus. It is inappropriate to apportion undue weight to radiological abnormalities that correlate poorly with symptoms

Aims: To find a long-term effect of posterolateral fusion for isthmic spondylolysis and spondylolisthesis on lumbar spine. Methods: A posterolateral fusion was performed on 56 patients (30 females, 26 males) with an average age of 16 (range 11 to 20) years. A clinical and MRI examination was performed on these patients on average 18 years later (range 11 to 25 years). The size of the spinal canal were assessed. Disc space, degeneration and protrusions were evaluated. Bone marrow changes (Modic I & II), facet joint degeneration and the state of the spinal muscles were assessed. Results: In MR images, none of the patients had lumbar spinal stenosis. In contrast, the spinal canal was wide in the level spondylolysis and spondylolisthesis. Narrowing of the neural foramina was noted in 13 (23%) patients. This was associated usually in severe slip (> 50%) and was noted always at the L5-S1 level. Of the studied 332 intervertebral discs 56 (17%) were speckled and 57 (17%) were black and 76 (23%) narrowed. Most commonly speckled/black and narrowed disc was found in the two lowest lumbar levels. Only one patient, 41-year-old female, had prolapse. Modic I and II changes were noted in 7 (2%) and 9 (3%) intervertebral disc levels, respectively. Degenerative-like facet joint hypertrophy was noted in 47 (48%) of the studied levels. Of the patients, seven (12%) had muscular atrophy. Conclusions: Stenosis of neural foramina may be associated to severe spondyolisthesis. Degenerative changes were found most commonly found in the level of the spondylolysis and spondylolisthesis and above fusion level. Bone marrow changes associated with disc degeneration were rare

The purpose of this study was to determine the significance of pedicular screw and segmental wire fixation for the treatment of spondylolysis. Twenty-five patients of spondylolysis were treated operatively. Seventeen patients of them had isthmic sondylolisthesis with an average displacement of 22% (ranges, 4–55%). Thirteen patients (6 patients had spondylolisthesis) were treated by the direct repair of the pars defect with bone graft with pedicular screw and wire fixation methods (Group A), and 12 patients (11 patients had spondylolisthesis) were treated by posterior lumbar interbody fusion or postero-lateral fusion (Group B). The mean age at the operation was 34 in the former, and 45 in the latter. The average volume of bleeding was 291ml in Group A and 840ml in Group B. Operative results were evaluated as excellent, good, fair and poor by Henderson’s evaluation of functional capacity. Radiographically, bony fusion rate was examined. The average follow-up period was 33 months. At the final follow-up stage, clinical outcome was excellent in 5 patients, good in 7, fair in 1, and poor in zero in Group A, and that was in 8,3,0, and one in Group B. Nerve roots irritation was observed in one patient in Group B postoperatively. Bony fusion rate was 100% in both groups. However, delayed union was observed in 2 cases of the Group A. The range of motion L5/sacrum increased to 10 degree from 9 degree (p=0.1). Spondylolysis with severe low back pain has been treated by major surgery like spondylodesis. This study showed that the direct repair of the pars defects is the acceptable methods for the treatment of spondylolysis either no or minimal spondylolisthesis

Low back pain is not a frequent complaint in adolescents and usually is a self-limited affliction without signs or significant findings in pertinent imaging studies. Adolescent athletes are in an increased risk of overuse injuries to the spine due to their relative ligamentous laxity and lack of proper technique in their chosen sport. This is a prospective study of adolescent athletes referred to the spine clinic due to low back pain and significant findings on physical examination and/or the imaging studies. Between 01.08.1998 and 31.03.2001 we have treated 7 athletes, 2 girls and 5 boys, average age 15.67 years (range 13–17). Sports involved were golf in 2, body building in 1, volleyball in 1, handball in 1, track and field in 1, and ballet in 1. Five were eventually diagnosed with L5 pars defects (2 unilateral and 3 with bilateral lesions); L2 spondylolysis was diagnosed in 1 and L5-S1 central disc protrusion in 1. All complained of pain located to the lower back, the patient with disc protrusion complained of pain radiating to her lower extremities. Plain films were diagnostic in 1 patient only with a unilateral L5 pars defect. Technetium bone scan showed increased uptake at the level of the lesion in all 6 patients with spondylolysis and was normal in the patient with L5-S1 disc protrusion. CT scans were performed in 4 patients and were diagnostic 2, MRI was performed in 2 patients and was diagnostic in both. The six patients with spondylolysis were treated by analgesics, rest for 3 months and then gradual supervised return to sports with modification of the swing in both golfers, decrease of training volume in the body builder and limiting the track and field athlete to running only. Both volleyball and handball players withdrew from athletic activities. The volleyball player with L5-S1 herniation refused surgical treatment. The evaluation of adolescent athletes with low back pain longer than few weeks, should be by bone scan first and CT and/or MRI later. MRI should be preferred to limit radiation exposure. After proper rest and supervised training they can safely resume their athletic interests

To determine how long after injury a single photon emission computed tomography (SPECT) scan may remain positive in cases of symptomatic posterior element lumbar stress injuries. SPECT scans can identify posterior element lumbar stress injuries earlier than other imaging modalities. As these lesions evolve and the spondylolysis becomes chronic, the SPECT scan tends to revert to normal even though healing of the defect has not occurred. The aim of this study was to determine how long after initial injury a SPECT scan might remain positive. One hundred and sixty-five patients (85 male, 80 female) between the ages of 8 and 38 years with suspicion of lumbar spondylolysis or posterior element lumbar stress injuries were investigated. All patients underwent plain radiographs, planar bone scintigraphy and SPECT imaging. The duration of symptoms at clinical assessment was recorded. The age, sex, symptom reproduction on flexion or extension, level of sporting activity, and the Oswestry Disability Index both pre- and post-treatment were also recorded. SPECT positive images (hot scans) were depicted as cases and SPECT negative images as controls. Univariate and multivariate analysis was performed. Eighty-five patients (63 male, 22 female) had positive SPECT scans (cases); eighty had negative scans (controls). The mean age at onset of symptoms was 20.2 years for cases and 17.4 years for controls. Bilateral increased uptake on SPECT scan was more common than unilateral. The commonest site for increased uptake was the posterior elements of the fifth lumbar vertebra. Low back pain in extension was more common in SPECT positive cases. The mean time from injury / onset of symptoms to a positive SPECT scan was 7.1 months (range 5.2–9.2 months) and to a negative SPECT scan was 22.5 months (range 16.8–28.4 months). Intense scintigraphic activity in the posterior elements of the lumbar spine was associated with a more recent injury and was concordant with the patient’s history and physical examination. Chronic, un-united spondylolysis was often scintigraphically occult. There was a window of approximately six months from the onset of symptoms to investigation after which the sensitivity of SPECT imaging diminished

Purpose and Background. Both overall spine shape and the size and shape of individual vertebrae undergo rapid growth and development during early childhood. Motor development milestones such as age of walking influence spine development, with delayed ambulation linked with spinal conditions including spondylolysis. However, it is unclear whether associations between motor development and spine morphology persist into older age. Therefore, these associations were examined using data from the MRC National Survey of Health and Development, a large nationally-representative British cohort, followed up since birth in 1946. Methods and Results. Statistical shape modelling was used to characterise spinal shape (L5-T10) and identify modes of variation in shape (SM) from dual energy x-ray absorptiometry images of the spine taken at age 60–64 years (N=1327 individuals; 51.8% female). Associations between walking age in months (reported by mothers at 2 years) and SMs were examined with adjustment for sex, birthweight, socioeconomic position, height, lean mass and fat mass. Later onset of independent walking was weakly associated with greater lordosis (SM1; P=0.05) and more uniform antero-posterior vertebral size along the spine (SM6, P=0.07). Later walking age was also associated with smaller relative anterior-posterior vertebral dimensions (SM3) among women whereas the opposite was found for men (P <0.01 for sex interaction). Conclusions. Spinal morphology in early old age was associated with the age that individuals began walking independently in childhood, potentially due to altered mechanical loading. This suggests that motor development may have a persisting effect on clinically-relevant features of spine morphology throughout life. Conflict of interest: None. Funded by the UK Medical Research Council (Grant MR/L010399/1) which supported FRS, SGM and AVP

To study the contribution of the special morphological features of lumbo-sacral spine as causes of the slipping in the spondylolisthesis, the roentgenographic measurements were performed in 47 cases of spondylolysis, 77 of spondylolisthesis and 597 of several low back pain as a control. The transitional lumbo-sacral spine was more frequently seen in the spondylolisthesis group, but there was no d ifference between the spondylolysis and control. The angle between the superior surface and the posterior border of the sacral vertebral body (posterior superior sacral angle) was apparently low in the spondylolisthesis, whereas no difference was noted between another groups. In conclusion, special morphological features such as low prices of the posterior superior sacral angle is considered one of the risk factors for the cause of slipping

The hook screw method is a direct repair technique that permits ‘restitutio ad integrum’ for a functional segment. The surgical method of treating spondylolysis and grade 1 spondylolisthesis by spondylytic hook screw reduction and bone grafting in 34 patients is reported. Of these patients, 32 showed good to excellent results. Surgical technique. The bone on either side of the defect is roughened. Then the screws are inserted after pre-drilling into the base of the articular process inclined at 400 to the vertebral endplate and diverging 15 to 20 degrees from each side. Then the special hooks, hooked under the lamina, are fixed to the screws by nuts over a spring so as to obtain compression over the defect. Autologous cancellous bone graft is placed in the defect. Materials and methods. A total of 34 patients were included in this study from 1998 to 2006, 32 male and 2 female patients. Pre-operative and post-operative Oswestry Lumbar Disability Index score (OLDI) and SF 36 scores recorded. Results. The response rate was 100%. The mean age of the patients was 34 years. Mean pre-operative OLDI score was 42 and post-operatively was 14. The results were subdivided into excellent, very good, good, no change and poor. An excellent result meant a greater than 15 point improvement on OLDI score; very good a 10-15 point improvement; good results a 5-10 point improvement. An excellent result was reported by 76% of patients, good to excellent results by 94% of patients and good and very good by 23 % of patients. 1 patient had no change and 1 was poor. Conclusion. Direct repair of spondylolysis can be recommended for young patients to save a functional segment. The above mean 6 year follow-up shows encouraging results

Introduction: Spondylolysis is amongst the commonest causes of low back pain in the athletic child. We observed increased uptake in the pedicles of the affected segment and a triangular pattern of uptake in the sagittal projection of tomographic studies of fractures of the pars interarticularis. The hypothesis that these observations were specific for fractures of the pars interarticularis was tested in a variety of spinal disorders. Methods:. A retrospective study of 25 young athletes with a variety of spinal disorders was undertaken (17males, 8 females; average age 13.5 years [range: nine to16 years]). The patients were referred from a specialised sports clinic. Back pain was present for an average of four months (Range six weeks to 11 months). All children had planar and tomographic scintigraphic bone scans with special reconstruction. The diagnosis was confirmed by radiological studies and/or response to treatment. Results:. All 15 children with spondylolysis had evidence of increased uptake in the ipsilateral (12/15) or contra-lateral pedicle (3/15). None of the cases of muscle insertion injury, facet joint or disc disease demonstrated this pattern. A triangular shaped pattern of uptake was only seen in the sagittal view of the tomographic studies in patients with fractures of the pars interarticularis. Conclusion:. We have described two unique features of spondylolysis that add to the confidence with which the scintigraphic diagnosis may be made