Asai Reo, Tatsumura Masaki, Okuwaki Shun, Gamada Hisanori, Funayama Toru, Hirano Atsushi, Yamazaki Masashi
Department of Medical Education and Training, Tsukuba Medical Center Hospital, Tsukuba, Japan.
Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Japan.
Spine Surg Relat Res. 2022 Jul 11;7(1):83-88. doi: 10.22603/ssrr.2022-0099. eCollection 2023 Jan 27.
Lumbar spondylolysis typically arises during adolescence, whereas its onset in adulthood is rare. Several studies have reported incidentally identified terminal-stage spondylolysis in adults, but only one case series has investigated acute lumbar spondylolysis lesions with bone marrow edema in adults.
We retrospectively investigated lumbar spondylolysis in patients aged 18 years or older. Age at diagnosis, sex, competitive sporting level, and competitive sporting discipline were investigated in each patient. The level of the affected vertebra, pathological stage, bone union, and treatment period were analyzed for each lesion.
The study included nine patients (eight males and one female), aged 18-22 years old, with 14 acute lumbar spondylolysis lesions. Four patients were soccer players (two professionals, and two amateurs), four were amateur track and field athletes, and one was an amateur basketball player. The affected vertebral levels were L3 in two lesions, L4 in seven lesions, and L5 in five lesions. The pathological stage was pre-lysis stage in two lesions, early stage in eight lesions, and progressive stage in four lesions. Ten lesions achieved bone union with conservative therapy. The average treatment period was 84.7 days.
The adult-onset lumbar spondylolysis patients were young, up to their early 20s, and generally professional sportspeople performing at an elite level. Most of them were performing a sport that has been reported to have a high risk of causing lumbar spondylolysis. L4 was the most affected vertebral level in contrast to L5, which has been reported in adolescent lumbar spondylolysis. Bone union was achieved for most lesions with conservative therapy.
腰椎峡部裂通常在青春期发病，而在成年期发病则较为罕见。多项研究报告了成人偶然发现的终末期峡部裂，但仅有一个病例系列研究了成人急性腰椎峡部裂伴骨髓水肿的病变情况。
我们回顾性研究了18岁及以上患者的腰椎峡部裂。调查了每位患者的诊断年龄、性别、竞技运动水平和竞技运动项目。分析了每个病变的受累椎体水平、病理阶段、骨愈合情况和治疗周期。
该研究纳入了9例患者（8例男性和1例女性），年龄在18 - 22岁之间，共有14处急性腰椎峡部裂病变。4例患者为足球运动员（2名职业球员和2名业余球员），4例为业余田径运动员，1例为业余篮球运动员。受累椎体水平为：2处病变位于L3，7处病变位于L4，5处病变位于L5。病理阶段为：2处病变处于裂前阶段，8处病变处于早期，4处病变处于进展期。10处病变通过保守治疗实现了骨愈合。平均治疗周期为84.7天。
成人发病的腰椎峡部裂患者较为年轻，多为20岁出头，且通常是高水平的职业运动员。他们中的大多数从事的运动据报道有较高的导致腰椎峡部裂的风险。与青少年腰椎峡部裂中报道的L5不同，L4是最常受累的椎体水平。大多数病变通过保守治疗实现了骨愈合。
