Increased sagittal diameter of the vertebral arch aids in diagnosis of lumbar spondylolysis
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SCIENTIFIC ARTICLE
Increased sagittal diameter of the vertebral arch aids in diagnosis of lumbar spondylolysis Shi-Zheng Chen 1,2,3 & An-Ni Tong 3 & He-Hu Tang 1,2 & Zhen Lv 1,2 & Shu-Jia Liu 1,2 & Jie-Sheng Liu 1,2 & Jun-Wei Zhang 1,2,3 Received: 26 August 2020 / Revised: 19 October 2020 / Accepted: 20 October 2020 # The Author(s) 2020
Abstract Objective To identify a diagnostic indicator of lumbar spondylolysis visible in plain X-ray films. Methods One hundred and seventy-two patients with low back pain who received X-ray and computerized tomography (CT) examinations were identified and studied. They were divided into three groups: the spondylosis without spondylolisthesis (SWS) group, comprising 67 patients with bilateral pars interarticularis defects at L5 and without spondylolisthesis, the isthmic spondylolisthesis (IS) group, comprising 74 patients with L5/S1 spondylolisthesis and bilateral L5 pars interarticularis defects, and the control group, comprising 31 patients with low back pain but without spondylolysis. The sagittal diameters of the vertebral arch (SDVAs) of L4 and L5 were measured in lateral X-ray image, and the differences in SDVA between L4 and L5 (DSL4-5) in each case were calculated and analyzed. Results There were no significant differences in demographic characteristics among the three groups. In the SWS and IS groups, the SDVA of L5 was significantly longer than the SDVA of L4 (p < 0.001), whereas no significant difference found in the control group (p > 0.05). DSL4-5, in which the SDVA of L4 was subtracted from the SDVA of L5, significantly differed among the three groups (p < 0.001), and the normal threshold was provisionally determined to be 1.55 mm. Conclusions In bilateral L5 spondylolysis, the SDVA of L5 is wider than the SDVA of L4, and this difference is greater in isthmic spondylolisthesis. This sign in lateral X-rays may provide a simple and convenient aid for the diagnosis of spondylolysis. Keywords Spondylolysis . Lumbar vertebrae . X-rays
Abbreviations L4 Lumbar 4 SDVA Sagittal diameter of the vertebral arch D S L 4 -Difference in SDVA between L4 and L5, calculated 5 by subtracting SDVA of L4 from the SDVA of L5 PID Pars interarticularis defect IS Isthmic spondylolisthesis SWS Spondylosis without spondylolisthesis LBP Low back pain CT Computerized tomography
* Jun-Wei Zhang [email protected] 1
Department of Spine and Spinal Cord Surgery, China Rehabilitation Research Center, Beijing, China
2
Department of Orthopedic Surgery, Capital Medical University, Beijing, China
3
Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China
Introduction Spondylolysis, derived from the Greek words spondylos (vertebra) and lysis (defect) [1–3], is defined as a unilateral or bilateral defect or abnormality of the pars interarticularis and surrounding lamina and pedicle. Approximately 80% of patients with spondylolysis are asymptomatic, and the defect is found incidentally. Spondylolysis can be a cause of low back pain (LBP) in children, adolescents, and adults, a
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