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Research article
Masaki Tatsumura
Tsukuba university hospital Mito clinical education center / Mito Kyodo General Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3679-9438
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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 pseudoarthrosis.
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 advanced pathological stage (p = 0.004), contralateral pseudoarthrosis (p < 0.001), and L5 lesion level (p = 0.002). The odds ratio was 20.0 (95% CI 3.0–193.9) for advanced pathological stage, 78.8 (95% CI 13–846) for contralateral pseudoarthrosis, 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 advanced, the lesion level is L5, or there is contralateral pseudoarthrotic spondylolysis.
Keywords
lumbar spondylolysis, union inhibitor, contralateral pseudarthrosis lesion, treatment failure and risk factor
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CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
No community comments so far
Editorial decision: Accept
On 28 Dec, 2020
Editor assigned
On 28 Dec, 2020
Submission checks complete
On 28 Dec, 2020
Editor invited
On 28 Dec, 2020
No comments provided
Editorial decision: Minor revision
On 23 Dec, 2020
Review #2 received
Received 17 Dec, 2020
Review #1 received
Received 05 Dec, 2020
Reviewer #2 agreed
On 23 Nov, 2020
Reviewers invited
Invitations sent on 22 Nov, 2020
Reviewer #1 agreed
On 22 Nov, 2020
Editor assigned
On 15 Nov, 2020
Submission checks complete
On 15 Nov, 2020
Editor invited
On 15 Nov, 2020
Version 1
Posted 23 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 09 Oct, 2020
Review #2 received
Received 07 Oct, 2020
Reviewer #2 agreed
On 03 Sep, 2020
Review #1 received
Received 07 Aug, 2020
Reviewer #1 agreed
On 18 Jul, 2020
Reviewers invited
Invitations sent on 24 Jun, 2020
Editor assigned
On 23 Jun, 2020
Submission checks complete
On 22 Jun, 2020
Editor invited
On 22 Jun, 2020
First submitted
On 16 Jun, 2020
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Subject Areas
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A new preprint design is coming!
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See the published version of this preprint at BMC Musculoskeletal Disorders.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Masaki Tatsumura
Tsukuba university hospital Mito clinical education center / Mito Kyodo General Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3679-9438
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
No community comments so far
Editorial decision: Accept
On 28 Dec, 2020
Editor assigned
On 28 Dec, 2020
Submission checks complete
On 28 Dec, 2020
Editor invited
On 28 Dec, 2020
No comments provided
Editorial decision: Minor revision
On 23 Dec, 2020
Review #2 received
Received 17 Dec, 2020
Review #1 received
Received 05 Dec, 2020
Reviewer #2 agreed
On 23 Nov, 2020
Reviewers invited
Invitations sent on 22 Nov, 2020
Reviewer #1 agreed
On 22 Nov, 2020
Editor assigned
On 15 Nov, 2020
Submission checks complete
On 15 Nov, 2020
Editor invited
On 15 Nov, 2020
Version 1
Posted 23 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 09 Oct, 2020
Review #2 received
Received 07 Oct, 2020
Reviewer #2 agreed
On 03 Sep, 2020
Review #1 received
Received 07 Aug, 2020
Reviewer #1 agreed
On 18 Jul, 2020
Reviewers invited
Invitations sent on 24 Jun, 2020
Editor assigned
On 23 Jun, 2020
Submission checks complete
On 22 Jun, 2020
Editor invited
On 22 Jun, 2020
First submitted
On 16 Jun, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Musculoskeletal Disorders.
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 pseudoarthrosis.
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 advanced pathological stage (p = 0.004), contralateral pseudoarthrosis (p < 0.001), and L5 lesion level (p = 0.002). The odds ratio was 20.0 (95% CI 3.0–193.9) for advanced pathological stage, 78.8 (95% CI 13–846) for contralateral pseudoarthrosis, 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 advanced, the lesion level is L5, or there is contralateral pseudoarthrotic spondylolysis.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
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