Department of Orthopaedic Surgery, Anshin Hospital, Kobe, Japan.
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Spine (Phila Pa 1976). 2024 Aug 1;49(15):1085-1091. doi: 10.1097/BRS.0000000000004849. Epub 2023 Oct 9.
Retrospective case series.
To report the detailed bone fusion rates and duration of treatment in unilateral and bilateral cases of pediatric lumbar spondylolysis (LS).
Early diagnosis and optimal conservative management for LS are crucial for achieving bony healing without surgery. However, existing research on the conservative treatment of pediatric LS, particularly regarding bone union rates and treatment duration for each stage of bilateral spondylolysis, is limited.
We retrospectively analyzed 590 pediatric patients (522 boys and 68 girls) under 18 years of age diagnosed with LS and treated conservatively from 2015 to 2021. The diagnosis was based on computed tomography scans and magnetic resonance imaging findings, with stages classified as very early, early, progressive, or terminal. Patient background, sports history, level and stage of spondylolysis, presence of spina bifida occulta, bone union rate, duration of conservative treatment, and recurrence rate were retrospectively analyzed.
The overall bone union rate was 81.9%, with a mean conservative treatment duration of 53.7 days. Unilateral LS cases showed decreased bone union rates with stage advancement (very early; 98.2%, early; 96.0%, progressive; 64.3%). Bilateral LS cases with progressive or terminal stage demonstrated low bone union rates (very early/very early; 100%, early/very early; 94.1%, progressive/very early; 66.7%, early/early; 82.9%, progressive/early; 32.3%, progressive/progressive; 23.7%, very early/terminal; 0%, early/terminal; 50.0%, progressive/terminal; 11.1%). The duration of conservative treatment extended as the stage of the main and contralateral lesions progressed, ranging from 39.1 days (very early/none) to 105 days (progressive/terminal). The recurrence rate after bone fusion was 16.6%, with no differences based on lesion stage.
In this series of 590 patients, conservative treatment yielded high bone union rates for pediatric LS. However, union rates decreased with stage advancement, especially in bilateral cases. These findings provide valuable insights for prognosticating natural history and outcome regarding LS treatment, bone union, and return to activity.
回顾性病例系列。
报告单侧和双侧小儿腰椎峡部裂（LS）的详细骨融合率和治疗持续时间。
早期诊断和 LS 的最佳保守治疗对于实现无手术愈合至关重要。然而，现有的小儿 LS 保守治疗研究，特别是关于双侧峡部裂各阶段的骨愈合率和治疗持续时间的研究有限。
我们回顾性分析了 2015 年至 2021 年期间接受保守治疗的 590 名年龄在 18 岁以下的小儿 LS 患者（522 名男孩和 68 名女孩）。诊断基于计算机断层扫描和磁共振成像结果，分期为极早期、早期、进展期或终末期。回顾性分析患者背景、运动史、峡部裂水平和分期、是否存在隐性脊柱裂、骨融合率、保守治疗持续时间和复发率。
总体骨融合率为 81.9%，平均保守治疗持续时间为 53.7 天。单侧 LS 病例随着分期进展，骨融合率降低（极早期；98.2%，早期；96.0%，进展期；64.3%）。进展期或终末期双侧 LS 病例骨融合率低（极早期/极早期；100%，早期/极早期；94.1%，进展期/极早期；66.7%，早期/早期；82.9%，进展期/早期；32.3%，进展期/进展期；23.7%，极早期/终末期；0%，早期/终末期；50.0%，进展期/终末期；11.1%）。随着主侧和对侧病变分期进展，保守治疗持续时间延长，从 39.1 天（极早期/无）到 105 天（进展期/终末期）。骨融合后复发率为 16.6%，与病变分期无关。
在本系列的 590 例患者中，保守治疗小儿 LS 的骨融合率较高。然而，随着分期进展，融合率降低，尤其是在双侧病例中。这些发现为 LS 治疗、骨融合和恢复活动的自然病史和结果的预后提供了有价值的见解。
