Department of Orthopedic Surgery, Anshin Hospital, Kobe, Japan.
Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Am J Sports Med. 2024 Sep;52(11):2866-2873. doi: 10.1177/03635465241270293. Epub 2024 Sep 2.
Pediatric lumbar spondylolysis, a stress fracture of the lumbar spine, frequently affects young athletes, and nonoperative treatment is often the first choice of management. Because the union rate in lumbar spondylolysis is lower than that in general fatigue fractures, identifying risk factors for nonunion is essential for optimizing treatment.
To determine the risk factors for nonunion after nonoperative treatment of acute pediatric lumbar spondylolysis through multivariate analysis.
Case-control study; Level of evidence, 3.
We analyzed 574 pediatric patients (mean age, 14.3 ± 1.9 years) with lumbar spondylolysis who underwent nonoperative treatment between 2015 and 2022. Nonoperative treatment included the elimination of sports activities, bracing, and weekly athletic rehabilitation, with follow-up computed tomography. Patient data, lesion characteristics, sports history, presence of spina bifida occulta at the lamina with a lesion or at the lumbosacral spine excluding the lesion level, and lumbosacral parameters were examined. Differences between the union and nonunion groups were investigated using multivariate analysis to determine the risk factors for nonunion.
Of the 574 patients, 81.7% achieved bone union. Multivariate analysis revealed that an L5 lesion and the progression of the main and contralateral lesion stages were significant independent risk factors for nonunion. An L5 lesion had a lower union rate than non-L5 lesions. As the main lesion progressed, the likelihood of nonunion increased significantly, and the progression of the contralateral lesion also showed a similar trend. Spina bifida occulta and lumbosacral parameters were not significant predictors of nonunion in this study.
We identified the L5 lesion level and the progression of the main and contralateral lesion stages as independent risk factors for nonunion in pediatric lumbar spondylolysis after nonoperative treatment. These findings aid in treatment decision-making. When bone union cannot be expected with nonoperative treatment, symptomatic treatment is required without prolonged external fixation and rest, and without aiming for bone union. Individualized treatment plans are crucial based on identified risk factors.
小儿腰椎峡部裂是一种腰椎的应力性骨折，常影响年轻运动员，非手术治疗通常是首选的治疗方法。由于腰椎峡部裂的愈合率低于一般疲劳性骨折，因此确定非愈合的风险因素对于优化治疗至关重要。
通过多因素分析确定小儿急性腰椎峡部裂非手术治疗后不愈合的危险因素。
病例对照研究；证据等级，3 级。
我们分析了 2015 年至 2022 年期间接受非手术治疗的 574 例小儿腰椎峡部裂患者（平均年龄 14.3±1.9 岁）。非手术治疗包括消除运动活动、支具和每周的运动康复，同时进行 CT 随访。检查患者数据、病变特征、运动史、病变处的隐性脊柱裂以及病变水平以外的腰骶部参数。使用多因素分析比较愈合组和未愈合组之间的差异，以确定非愈合的危险因素。
574 例患者中，81.7%达到骨愈合。多因素分析显示，L5 病变和主侧及对侧病变分期进展是未愈合的显著独立危险因素。L5 病变的愈合率低于非 L5 病变。随着主侧病变的进展，未愈合的可能性显著增加，对侧病变的进展也呈现出类似的趋势。隐性脊柱裂和腰骶部参数在本研究中不是未愈合的显著预测因素。
我们确定了 L5 病变水平以及主侧和对侧病变分期的进展是小儿腰椎峡部裂非手术治疗后不愈合的独立危险因素。这些发现有助于治疗决策。当非手术治疗无法预期骨愈合时，需要进行有症状的治疗，而无需长时间的外固定和休息，也无需追求骨愈合。基于确定的风险因素，个体化治疗计划至关重要。
