Introduction. Lumbar spondylolysis is a fatigue fracture of the pars interarticularis and correlates with Spina Bifida Oculta (SBO) in 67%. Hpothesis. Load is normally transferred across the arch in axial rotation. Bifid arch results in increased strain across the isthmus of the loaded inferior articular process. Aim of investigation. Finite element (FE) analysis of altered load transfer in combined axial rotation and anteroposterior shear in SBO potentially predisposing to fatigue fracture of the pars interarticularis. Methods. FE models of natural and SBO (L5-S1) including ligaments were axially load to 1kN and an axial rotation of 3° applied. Bilateral stresses and strains on intact and SBO lateral inferior lines of the L5 isthmus were assessed and compared. Results. Under 1000N axial load: Maximum von Mises stress observed on left and right lateral inferior lines of L5 isthmus were 0.13 and 0.24 MPa, with maximum equivalent strain values of 1.56 and 2.91 (strain, for natural spine and SBO, respectively. Combined with 3° axial rotation (rotation of spinal processes toward right lateral side): Left lateral L5 isthmus stresses increased to 0.49 and 0.77 MPa for natural spine and SBO, respectively. Right lateral L5 isthmus values increased to 0.67 and 0.95 MPa for natural spine and SBO, respectively. The percentage increase in SBO strains compared to the natural spine on the L5 isthmus were +57.9 and +40.2%. Conclusion. Significant load transfer occurs through the vertebral arch in axial rotation. In SBO this load transfer is lost and mechanical demand on the isthmus is significantly increased. Strain increases across the L5 isthmus in axial rotation by +40.2% to +57.9% compared to normal and may predispose to fatigue fracture

Aims

Magnetically controlled growing rods (MCGR) have been gaining popularity in the management of early-onset scoliosis (EOS) over the past decade. We present our experience with the first 44 MCGR consecutive cases treated at our institution.

Back pain is a common symptom in children and adolescents. Here we review the important causes, of which defects and stress reactions of the pars interarticularis are the most common identifiable problems. More serious pathology, including malignancy and infection, needs to be excluded when there is associated systemic illness. Clinical evaluation and management may be difficult and always requires a thorough history and physical examination. Diagnostic imaging is obtained when symptoms are persistent or severe. Imaging is used to reassure the patient, relatives and carers, and to guide management.

Cite this article: Bone Joint J 2014;96-B:717–23.