Isolated and Multilevel Spondylolysis (Literature Review)

Cover Page


Cite item

Full Text

Abstract

One of the main causes of lumbar spine pain is spondylolysis. The purpose of this review is to present the current state of the problem of diagnosis and treatment isolated and multilevel spondylolysis.

Materials and Methods. The review includes 86 publications on the problem of spondylolysis for 2005–2019, obtained from electronic databases: PubMed, Cochrane Library, eLIBRARY, CYBERLENINKA.

Results. There is still the only known classification of spondylolysis by P. Niggemann et al, which includes four severity of this pathology — from mild to very severe: A, BI, BII, BIII. The classification is based on the nature of changes in the area of bone defect of the vertebral arch when the patient performs functional tests. In some cases, the pathology can be regarded as a transition between different degrees of severity of type B. The treatment of spondylolysis can be both conservative and operational. The conservative therapy consists of physical activity restriction, physiotherapy, wearing a corset, massage, and pharmacotherapy. The purpose of surgical treatment is the removal of fibrous tissue from the zone of spondylolysis and the achievement in this area the bone fusion via a bone autoplasty and(or) osteosynthesis with different metal frameworks. Reasoned arguments about the need for a combination of conservative and surgical treatment of patients with spondylolysis are also reflected in the publications. Information on multilevel spondylolysis is represented by a small number of articles. only 15 authors described clinical cases of multilevel spondylolysis in a total of 21 patients. Spondylolysis is a high risk factor for the spondylolisthesis formation. Among the various categories of patients suffering from spondylolysis and lumbar spondylolysis spondylolisthesis, pregnant women are of particular interest. Hormonal restructuring and changes in the biomechanics of the spine in women during the gestational period often leads to the appearance or intensification pain syndrome in lumbar spine complicating the pregnancy, and hence a fetus development.

Conclusion. Timely diagnosis of spondylolysis and the subsequent development of individual rehabilitation not only improves the quality of life of patients, but in some cases can prevent such a serious pathology as spondylolisthesis.

About the authors

E. G. Skryabin

Tyumen State Medical University

Author for correspondence.
Email: skryabineg@mail.ru

Evgeny G. Skryabin — Dr. Sci. (Med.), professor, Department of Traumatology and Orthopedics with a Course in Pediatric Traumatology

Tyumen

Russian Federation

References

  1. Gezer N.S., Balci A., Kalemci O., Köremezli N., Başara Akın I., Ur K. Vertebral body bone mineral density in patients with lumbar spondylolysis: a guantitative cT study. Diagn Interv Radiol. 2017;23(5):385-389. doi: 10.5152/dir.2017.16463.
  2. Scharifi G., Jahanbakhshi A. Daneshpajouh B., Rahimzadeh A. Bilateral Three-lewell lumbar Spondylolisis Repaired by Hook-Screw Technigue. Global Spine J. 2012;21(1):51-56. doi: 10.1055/s-0032-1307255.
  3. Скрябин Е.Г. Спондилолиз и спондилолизный спондилолистез нижних поясничных позвонков у детей и подростков. Гений ортопедии. 2017;23(1):71-73. doi: 10.18019/1028-4427-2017-23-1-71-73.
  4. Kim H.J., Crawford C.H., Ledonio C., Bess S., Larson A.N., Gates M. et al. Current evidence regarding the diagnostic methods for pediatric lumbar spondylolysthesis: a report from the scoliosis research society evidence based medicine committee. Spine Deform. 2018;6(2):185-188. doi: 10.1016/j.jspd.2017.08.010.
  5. Bourassa-Moreau E., Labell H., Parent S., Hresko M.T., Sucato D., Lenke L.G. et al. Expectation for postoperative improvement in health-related quality of life in young patients with lumbosacral spondylolysthesis: a prospective cohort study. Spine (Phila Pa 1976).2019;44(3):181-186. doi: 10.1097/BRS.0000000000002788.
  6. Deckey D.G., Kalish L.A., Hedeguist D., Emans J., Proctor M., Glotzbecker M. et al. Surgical Treatment of Developmental Spondylolysthesis: contemporary Series With a Two-Surgeon Team. Spine Deform. 2019;7(2):275-285. doi: 10.1016/j.jspd.2018.08.004.
  7. Warner W.C., Mendonça R.G.M. Adolescent spondylolysis: management and return to play. Instr Course Lect. 2017;66:409-413.
  8. Garry J.P., Mcshane J. Lumbar spondylolisis in adolescent athletes. J Fam Pract. 1998;47(2):145-149.
  9. Yurube T., Kakutani K., Okamoto K., Manabe M., Maeno K., Yoshikawa M. et al. Lumbar spondylolysis: areport of four cases from two generations of a family. J Orthop Surg (Hong Kong). 2017;25(2):2309499017713917. doi: 10.1177/2309499017713917.
  10. Скрябин Е.Г., Колунин Е.Т. Профилактика травм и обострений заболеваний позвоночного столба в процессе спортивной подготовки. Теория и практика физической культуры. 2018;(7):33-35.
  11. Нейгебауэр Ф.Л. К науке о так называемом соскальзывании позвонков. В кн.: Труды II съезда русских врачей. М., 1887. С. 6-8.
  12. Митбрейт И.М. Спондилолистез. М.: Медицина, 1978. 272 с.
  13. Продан А.И., Грунтовский А.Г., Куценко В.А., Колесниченко В.А. Диспластический спондилолистез: обзор современных концепций лечения. Хирургия позвоночника. 2004;(4):23-33.
  14. Wren T.A.L., Ponrartana S., Aggabao P.C. Increased lumbar lordosis and smaller vertebral crosssectional area are associated with spondylolysis. Spine (Phila Pa 1976). 2018;43(12):833-838. doi: 10.1097/BRS.0000000000002480.
  15. Nielsen E., Andras L.M., Skaggs D.L. Diagnosis spondylolysis and spondylolysthesis is delayed six months after seeing nonorthopedic providers. Spine Deform. 2018;6(3):263-266. doi: 10.1016/j.jspd.2017.10.008.
  16. Yamamoto N., Miki T., Nasu Y., Nishiyama A., Dan’Ura T., Matsui Y., Ozaki T. Congenital double-level cervical spondylolysis: a case report and review of the literature. Eur Spine J. 2017;26 (Suppl 1):181-185. doi: 10.1007/s00586-017-5005-y.
  17. Kushare I.V., Colo D., Kadhim M., Dormans J.P. Bilateral c6 spondylolysis with spondylolisthesis in 3 adolescent siblings. J Pediatr Orthop. 2014;34(7):e40-43. doi: 10.1097/BPo.0000000000000175.
  18. Sairyo K., Sakai T., Yasui N., Kiapour A., Biyani A., Ebraheim N., Goel V.K. Newly occurred l4 spondylolysis in the lumbar spine with pre-existence l5 spondylolysis among sports players: case reports and biomechanical analysis. Arch Orthop Trauma Surg.2009;129(10):1433-1439. doi: 10.1007/s00402-008-0795-3.
  19. Lawrence K.J., Elser T., Stromberg R. Lumbar spondylolysis in the adolescent athlete. Phys Ther Sport. 2016;20:56-60. doi: 10.1016/j.ptsp.2016.04.003.
  20. Kessous E., Borsinger T., Rahman A., D’Hemecourt P.A. Contrlateral spondylolysis and fracture of the lumbar pedicle in a young athlete. Spine (Phila Pa 1976). 2017;42(18):Е1087-Е1091. doi: 10.1097/BRS.0000000000002086.
  21. Kolcun J.P.G., Cheing L.O., Madhavan K., Wang M.Y. Mininal-invasive versus conventional repair of spondylolysis in athletes: a review of outcomes and return to play. Asian Spine J. 2017; 11(5): 832-842. doi: 10.4184/asj.2017.11.5.832.
  22. Selhorst M., Fischer A., Macdonald J. Prevalence of spondylolysis in symptomatic adolescent athletes: an assessment of sport risk in nonelite. Clin J Sport Med. 2017;14. doi: 10.1097/jSM.0000000000000546. [epub ahead of print].
  23. Schmidt T., Heini P., Benneker L. Arare case of non-traumatic, multi-level, bilateral pedicle fractures of the lumbar spine in a 60-year-old patient. Eur Spine J. 2017;26(Suppl 1):197-201. doi: 10.1007/s00586-017-5029-3.
  24. Bartochowski Ł., Jurasz W., Kruczyński J. Aminimal soft tissue damage approach of spondylolisis repair in athletes: preliminary report. Eur J Orthop Surg Traumatol. 2017;27(7):1011-1017. doi: 10.1007/s00590-017-1974-0.
  25. Grodahl L.H., Fawcett L., Nazareth M., Smith R., Spencer S., Heneghan N., Rushton A. Diagnostic utility of patient history and physical examination data to detect spondylolysis and spondylolisthesis in athletes with low back pain: a systematic review. Man Ther. 2016:24:7-17. doi: 10.1016/j.math.2016.03.011.
  26. Hanke L.F., Tuakli-Wosornu Y.A., Harrison J. The relationship between sacral slope and symptomatic spondylolisis in a cohort of high school athletes: a retrospective analysis. PM R. 2018;10(5):501-506. doi: 10.1016/j.pmrj.2017.09.012.
  27. Devalan J.A., Stence N.V., Mirsky D.M., Gralla J., Fadell M.F. Confidence in assessment of lumbar Spondylolysis using Three-Dimensional Volumetric T2-Weigfted MRI compared With limited field of View, Decreased-Dose cT. Sports Health. 2016;8(4):364-371. doi: 10.1177/1941738116653587.
  28. Hersh D.S., Kim Y.H., Razi A. Multi-Level spondylolysis. Bull NYU Hosp Jt Dis. 2011;69(4):339-343.
  29. D’angello Del Campo M.D., Suby J.A., Garcíalaborde P., Guichón R.A. Spondylolysis in the past: a case study of hunter-gatherers from Southern Patagonia. Int J Paleopathol. 2017;19:1-17. DOI: 10. 1016/j.ijpp.2017.07.001.
  30. Lemoine T., Fournier J., Odent T., Sembély-Taveau C., Merenda P., Sirinelli D., Morel B. The prevalence of lumbar spondylolysis in young children: a retrospective analysis using cT. Eur Spine J. 2018;27(5):1067-1072. doi: 10.1007/s00586-017-5339-5.
  31. Nitta A., Sakai T., Coda Y., Takata Y., Higashino K., Sakamaki T., Sairyo K. Prevalence of symptomatic lumbar spondylolysis in pediatric patients. Orthopedics. 2016;39(3): e434-437. doi: 10.3928/01477447-20160404-07.
  32. Kalichman L., Guermazi A., Li L., Hunter D.J., Suri P. Faset orientation and Tropism: associations with Spondylolisis.J Spinal Disord Tech.2010;23(2):101-105. doi: 10.1097/BSD.0b013e31819afb80.
  33. Kalichman L., Kim D.H., Li L., Guermazi A., Berkin V., Hunter D.J. Spondylolisis and spondylolisthesis: prevalence and association with low back pain in the adult communitybased population. Spine (Phila Pa 1976). 2009;34(2):199-205. doi: 10.1097/BRS.0b013e31818edcfd.
  34. Gregg C.D., Dean S., Schneiders A.G. Variables associated with active spondylolisis. Phys Ther Sport. 2009;10(4):121-124. doi: 10.1016/j.ptsp.2009.08.001.
  35. Скрябин Е.Г., Шарыпова А.А. Взаимосвязь заболеваний позвоночника и стоп у детей. Медицинская наука и образование Урала. 2016;17(2):45-48.
  36. Lee G.W., Lee S.M., Suh B.G. Direct repair surgery with screw fixation for young patients with lumbar spondylolysis: patient-reported outcomes and fusion rate in a prospective interventional study. Spine (Phila Pa 1976). 2015;40(4):e240-241. doi: 10.1097/BRS.0000000000000714.
  37. Panteliadis P., Nagra N.S., Edwards K.L., Behrbalk E., Boszczyk B. Athletic Population with Spondylolysis: Review of outcomes following Surgical Repair or conservative. Clobal Spine J. 2016;6(6):615-625. doi: 10.1055/s-0036-1586743.
  38. Надулич К.А., Теремшонок А.В., Нагорный Е.В. Лечение пациентов со спондилолистезом методом костной аутопластики и остеосинтеза дужки позвонка. Хирургия позвоночника. 2011;(1):16-19. doi: 10.14531/ss2011.1.16-19.
  39. Saraste H. Symptoms in relation to the level of spondylolysis. Int Orthop. 1986;10(3):183-185. doi: 10.1007/bf00266206.
  40. Alton T.B., Patel A.M., Lee M.J., Chapman J.R. Pediatric cervical spondylolysis and american football. Spine J. 2014;14(6):1-5. DOI: 0.1016/j.spinee.2013.09.037.
  41. Paik N.C. Bilateral cervical spondylolysis of c7. Spine J. 2010;10(11):e10-13. doi: 10.1016/j.spinee.2010.08.024.
  42. Ahn P.G., Yoon D.H., Shin H.C., Kim K.N., Lee D.Y., Yang M.S., Ha Y. Cervical spondylolysis: three cases and review current literature. Spine (Phila Pa 1976). 2010;35(3):e80-83. doi: 10.1097/BRS.0b013e3181b95dea.
  43. Губин А.В., Ульрих Э.В. Синдромальный подход к ведению детей с пороками развития шейного отдела позвоночника. Хирургия позвоночника. 2010;(3):14-19. doi: 10.14531/ss2010.3.14-19.
  44. Farah K., Pech-Gourg G., Graillon T., Scavarda D., Fuentes S. Anew minimally invasive technigue for primary unstable c2 spondylolysis in an 8-year-old child: a case report and review of the literature. World Neurosurg. 2018;115:79-84. doi: 10.1016/j.wneu.2018.04.013.
  45. Kim W.J., Song Y.D., Choy W.S. Multilevel thoracolumbar spondylolisis with spondylolisthesis at l4 on l5. Clin Orthop Surg. 2015;7(3):410-413. doi: 10.4055/cios.2015.7.3.410.
  46. Tezuka F., Sairyo K., Sakai T., Dezawa A. Etiology of adult-onset stress fracture in the lumbar spine. Clin Spine Surg. 2017;30(3):e233-e238. doi: 10.1097/BSD.0000000000000162.
  47. Виссарионов С.В., Мурашко В.В., Белянчиков С.М., Кокушин Д.Н., Солохина И.Ю., Гусева И.А. и др. Хирургическое лечение спондилолистеза l5 позвонка у детей. Возможности заднего доступа. Ортопедия, травматология и восстановительная хирургия детского возраста. 2014;2(3):24-33. doi: 10.17816/PToRS2324-33.
  48. Randall R.M., Silverstein M., Goodwin R. Review of pediatric spondylolysis and spondylolysthesis. Sports Med Arthrosc Rev. 2016;24(4):184-187. doi: 10.1097/jSa.0000000000000127.
  49. Lyras D.N., Tilkeridis K., Stravrakis T. Progression of spondylolisis to istmic spondylolisthesis in an adult without accompanying disc degeneration: a case report. Acta Orthop Belg. 2008;74(1):141-144.
  50. Mccunniff P.T., Yoo H., Yu C., Bajwa N.S., Toy J.O., Ahn U.M., Ahn N. Spondylolysis and end plate arthrosis at l5-S1: a cadaveric study. Orthopedics. 2017;40(1):e59-e64. doi: 10.3928/01477447-20160915-03.
  51. Mora de Sambricio A., Garrido-Stratenwerth E. Spondylolysis and spondylolisthesis in children and adolescents. Rev Esp Cir Ortop Traumatol. 2014;58(6):395-406. doi: 10.1016/j.recot.2014.05.009. (In Spanish).
  52. Ravichandran G. Multiple lumbar spondylolisis. Spine (Phila Pa 1976). 1980;5(6):552-557.
  53. Urrutia J., Zamora T., Cuellar J. Does the prevalence of spondylolysis and spina bifida occulta observed in pediatric patients remain stable in adulys? Clin Spine Surg. 2017;30(8):e1117-e1121. doi: 10.1097/BSD.0000000000000209.
  54. Libson E., Bloom R.A., Shapiro Y. Scoliosis in young men with spondylolisis or spondylolisthesis. a comparative study in symptomatic and asymptomatic subjects. Spine (Phila Pa 1976). 1984;9(5):445-447.
  55. Михайловский М.В., Садовой М.А., Белозеров В.В. Сколиоз и спондилолистез: обзор литературы. Хирургия позвоночника. 2017;14(3):23-31. doi: 10.14532/ss2017.3.23-31.
  56. Mohammed N., Patra D.P., Narayan V., Savardekar A.R., Dossani R.H., Bollqm P. et al. A comparasion of the technigues of direct pars interarticularis repairs for spondylolisis and low-grade spondylolisthesis:a meta-analysis. Neurusurg Focus. 2018;44(1):e10. doi: 10.3171/2017.11.focuS17581.
  57. Виссарионов С.В., Мурашко В.В., Дроздецкий А.П., Крутелев Н.А., Белянчиков С.М. Современный подход к лечению спондилолистеза у детей. Хирургия позвоночника. 2009;(3):56-63.
  58. Kirby D.J., Dietz H.C., Sponseller P.D. Spondylolysthesis is common early and severe in loyes-dietz syndrome. J Pediatr Orthop. 2018;38(8):e455-e461. doi: 10.1097/BPo.0000000000001203.
  59. Булатов А.В., Климов В.С., Евсюков А.В. Хирургическое лечение спондилолистезов низкой степени градации: современное состояние проблемы. Хирургия позвоночника. 2016;13(3):68-77. doi: 10.14531/ss2016.3.68-77.
  60. Niggemann P., Kuchta J., Hadizadech D., Pieper C.C., Schild H.H. Classification of spondylolytic clefts in patients with spondylolysis or isthmic spondylolisthesis using positional MRI. Acta Radiol. 2017;58(2):183-189. doi: 10.1177/0284185116638566.
  61. Goda Y., Sakai T., Harada T., Takao S., Takata Y., Higashino K. et al. Degenerative changes of the faset joints in adults with lumbar spondylolysis. Clin Spine Surg. 2017;30(6):e738-e742. doi: 10.1097/BSD.0000000000000217.
  62. Dhouib A., Tabard-Fougere A., Hanguinet S., Dayer R. Diagnostic accuracy of MR imaging for direct visualization of lumbar pars defect in children and young adults: a systematic review and meta-analysis. Eur Spine J. 2018;27(5):1058-1066. doi: 10.1007/s00586-017-5305-2.
  63. Kim M.W., Lee K.Y., Lee S. Factors associated with the symptoms of young adults with l5 spondylolysis. Asian Spine J. 2018;12(3):476-483. doi: 10.4184/asj.2018.12.3.476.
  64. Raudenbush B.L., Chambers R.C., Silverstein M.P., Goodwin R.C. Indirect pars repair for pediatric isthmic spondylolysis: a case series. J Spine Surger. 2017;3(3): 387-391. doi: 10.21037/jss.2017.08.08.
  65. Dunn A.S., Baylis S., Ryanc D. Chiropractic management of mechanical low back pain secondary to multi-level lumbar spondylolisis with spondylolisthesis in a united States Marine corps veteran: a case report. J Chiropr Med. 2009;8(3):125-130. doi: 10.1016/j.jcm.2009.04.003.
  66. Колчанов К.В. ЭМГ-признаки проявления корешкового синдрома у больных со спондилолистезом l4-l5 позвонков. Здоровье и образование в XXI веке. 2007;10:364.
  67. Tofte J.N., Carllee T.L., Holte A.J., Sitton S.E., Weinstein S.L. Spondylolysis: a systematic review. Spine (Phila Pa 1976). 2017;42(10):777-782. doi: 10.1097/BRS.0000000000001912.
  68. Grantham S.A., Imbriglia J.E. Double-level spondylolisis and transitional vertebra. case report. J Bone Joint Surg Am. 1975;57(5):713-714.
  69. Al-Sebai M.W., Al-Khawashki H. Spondyloptosis and multi-level spondylolisis. Eur Spine J. 1999;8(1):75-77. doi: 10.1007/s005860050130.
  70. Chang J.H., Lee C.H., Wu S.S., Lin L.C. Management of multiple level spondylolisis of the lumbar spine in young males: a report of six cases. J Formos Med Assoc. 2001;100(7):497-502.
  71. Мазуренко А.Н. Спондилодез поясничного отдела позвоночника при дегенеративных поражениях и деформациях. Медицинские новости. 2011;(7):20-26.
  72. Sakai T., Tezuka F., Yamashita K., Takata Y., Higashino K., Nagamachi A., Sairyo K. Conservative treatment for bony healing in pediatric lumbar spondylolysis. Spine (Phila Pa 1976). 2017;42(12):e716-e720. doi: 10.1097/BRS.0000000000001931.
  73. Wong L.C. Rehabilitation of a patient with a rare multi-level istmic spondyloliethesis: a case report. J Can Chiropr Assoc. 2004;48(2):142-151.
  74. Arai T., Sairyo K., Shibuya I., Kato K., Dezawa A. Multilevel direct repair surgery for three-level lumbar spondylolisis. Case Rep Orthop. 2013;2013:472968. doi: 10.1155/2013/472968.
  75. Eingorn D., Pizzutillo P.D. Pars interarticularis fusion on multitalle levels of lumbar Multiple lower lumbar spondylolisis. Spine (Phila Pa 1976). 1985;10(3):250-252.
  76. Mohi Eldin M. Minimal access direct spondylolisis repair using a pedicle screw – rod system: a case series. J Med Case Rep. 2012;6:396. doi: 10.1186/1752-1947-6-396.
  77. Mo J., Zhang W., Zhong D., Xu H., Wang L., Yu J., Luo Z. Is preventative long-segment surgery for multi-livel spondylolisis necessary? PLoS One. 2016;11(2):e0149707. doi: 10.1371/journal.pone.0149707.
  78. Voisin M.R., Witiw C.D., Deorajh R., Guha D., Oremakinde A., Wang S., Yang V. Multilevel spondylolysis repair using the «smiley face» technigue with 3-dimensional intraoperative spinal navigation. World Neurosurg. 2018;109:e609-e614. doi: 10.1016/j.wneu.2017.10.046.
  79. Privett J.T., Middlemiss J.H. Multiple lower lumbar spondylolisis. Br J Radiol. 1975;48(574):866-869. doi: 10.1259/0007-1285-48-574-866.
  80. Park K.H., Ha J.W., Kim H.S., Moon S.H., Lee H.M., Kim H.J., Kim J.Y. Multiple levels of lumbar spondylolisis – a case report. Asian Spine J. 2009;3(1):35-38. doi: 10.4184/asj.2009.3.1.35.
  81. Zhang C., Ye C., Lai Yu., Liu H., Ne T., Zhang H. et al. Two-lewel lumbar spondylolysis and spondylolysthesis: a retrospective study.J Orthop Surg Res. 2018;13(1):55. doi: 10.1186/s13018-018-0723-3.
  82. Saraste H. Spondylolysis and pregnancy: risk analisis. Acta Obstet Gynecol Scand. 1986;65(7):727-729.
  83. Brynhildsen J., Hansson P., Persson M., Hammar M. Monitoring patients with lower back pain during pregnancy.Obstet Gynecol. 1998;91(2):182-186.
  84. Heidary P., Farahbakhsh F., Rostami M., Noormahammadpour P., Kordi R. The role of ultrasound in diagnosing the cases of pain low back: review of literature. Asian J Sports Med. 2015;6(1):e23803. doi: 10.5812/asjsm.23803.
  85. Скрябин Е.Г., Решетникова Ю.С., Юхвид Е.В. Спондилолистез у беременных женщин: особенности клиники, диагностики, лечения. Дальневосточный медицинский журнал. 2009;(2):51-53.
  86. Дуров М.Ф., Скрябин Е.Г. Клиническая картина заболеваний позвоночника у беременных женщин, оперированных ранее по поводу вертеброгенной патологии. Хирургия позвоночника. 2007;(1):64-68.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c)


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies