Desouza Clevio, Jani Chiranjivi, Patil Vishal
Department of Orthopaedics, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune. Maharashtra. India.
J Orthop Case Rep. 2022 Feb;12(2):42-44. doi: 10.13107/jocr.2022.v12.i02.2658.
The leading cause of low back pain in our country like India in children and in adolescent has been found to be lumbar spondylolysis. This affects approximately 6-8% of adults in the general population which includes a large number of asymptomatic cases. The main cause in this disease is found to be that of fatigue features which are found in 10% of young adults during heavy labor work, sports, and athletic activities.
A 25-year-old, left hand dominant, cricket player was referred to Dr. DY Patil Hospital and Research Centre, Pimpri, Pune with complaint of low back pain while playing cricket with no neurological symptoms. His symptoms started 6 months back to this visit and have worsened despite conservative treatment with medications and rehabilitation. No obvious line was seen on the X-rays, but a right non-isthmic spondylolysis was noted at L5 on computed tomography scan. Based on our imaging findings and clinical examination, we made a diagnosis of non-isthmic spondylolysis. As the patient desired an early return to activity, we did not aim for bone union and provided pain relieving treatment which included temporary wearing of soft brace. As a result his pain improved.
In our case, the fracture type is more coronally oriented compared with a fracture line in typical spondylolysis. Furthermore, lifting weights transmit a force from the upper limb to lower limbs, it is likely that high loading causes this type of fracture. From a view of biomechanics, reducing extension loading should be an effective means in the treatment of this type of fracture.
在我国，如印度，儿童和青少年下背痛的主要原因已被发现是腰椎峡部裂。这在普通人群中约影响6 - 8%的成年人，其中包括大量无症状病例。该疾病的主要原因被发现是疲劳特征，在10%的年轻人进行重体力劳动、运动和体育活动时会出现。
一名25岁、惯用左手的板球运动员因在打板球时出现下背痛但无神经症状，被转诊至浦那皮姆普里的DY帕蒂尔医院和研究中心。他的症状在此次就诊前6个月开始，尽管接受了药物和康复的保守治疗仍有所加重。X线片未见明显异常，但计算机断层扫描显示L5右侧存在非峡部裂性腰椎峡部裂。基于我们的影像学检查结果和临床检查，我们诊断为非峡部裂性腰椎峡部裂。由于患者希望早日恢复活动，我们未以骨愈合为目标，而是提供了包括临时佩戴软支具在内的止痛治疗。结果他的疼痛有所改善。
在我们的病例中，与典型腰椎峡部裂的骨折线相比，骨折类型更呈冠状位。此外，举重会将力量从上肢传递到下肢，很可能是高负荷导致了这种类型的骨折。从生物力学角度来看，减少伸展负荷应该是治疗这种类型骨折的有效方法。
