Painful lumbar spondylolysis among pediatric sports players: a pilot MRI study
Painful lumbar spondylolysis among pediatric sports players: a pilot MRI study
复制标题
DOI：
10.1007/s00402-011-1336-z
复制
发表时间：
2011-11-01
影响因子：
2.3
通讯作者：
Dezawa, Akira
中科院分区：
文献类型：
--
作者：
Sairyo, Koichi;Sakai, Toshinori;Dezawa, Akira
对于非常活跃的运动员的儿童和青少年来说，新鲜的腰椎峡部裂是下腰痛(LBP)的主要病理原因。然而，对于终末期腰椎峡部裂(PARS缺陷)，很少有研究阐明LBP的发病机制。本研究的目的是阐明与运动员PARS缺陷相关的LBP的原因。本文对6名18岁以下患有痛性双侧腰椎峡部裂的儿童运动员(男5名，女1名)进行了评估，这是首次报道现役运动员合并痛性腰椎峡部裂的可能的发病机制。所有病例CT扫描均诊断为终末期(假关节)椎弓峡部裂。为了评估缺损区周围的炎症反应，在矢状面上进行了短时反转恢复(STIR)MRI检查。体液收集是炎性事件的一个指标，在12个节段缺损处以及12个头尾相邻小关节处进行了评估。在6个受试者的假性关节节段缺损处的所有12个节段缺损处观察到了炎症(即体液收集)。在小关节方面，在STIR MRI上，7/12(58%)的小关节缺损处有液体聚集在颅骨和(或)尾部邻近关节。因此，不难理解，在体育活动中，炎症如何首先发生在假关节部位，然后扩散到邻近的小关节。这一机制可能导致运动员终末期(假关节炎性)腰椎峡部裂相关的LBP。
For children and adolescents who are very active athletes, fresh lumbar spondylolysis is the main pathologic cause of lower back pain (LBP). However, regarding the terminal-stage spondylolysis (pars defect), there have been few studies to clarify the pathomechanism of LBP. The purpose of this study is to clarify the cause of LBP associated with pars defects in athletes. This is the first report showing a possible pathomechanism of LBP in active athletes with painful pars defect.Six pediatric athletes (5 boys and 1 girl) below 18 years old with painful bilateral lumbar spondylolysis were evaluated. In all cases, spondylolysis was identified as terminal stage (pseudoarthrosis) on CT scan. To evaluate the inflammation around the pars defects, short time inversion recovery (STIR) MRI was performed along with the sagittal section. Fluid collection, which is an indicator of inflammatory events, was evaluated in 12 pars defects as well as in 12 cranial and caudal adjoining facet joints.Inflammation (i.e., fluid collection) was observed in all 12 pars defects in six subjects at the pseudoarthrotic pars defects. In terms of facet joints, 7 of 12 (58%) pars defects showed fluid collection at the cranial and/or caudal adjoining joints on STIR MRI.The present study showed that inflammation was always present at the pars defects and in some cases at the adjoining facet joints. Thus, it is not difficult to understand how, during sports activity, inflammation may first occur at the pseudoarthrotic site and then spread to the adjoining facet joints. This mechanism could cause LBP associated with terminal-stage (pseudoarthrotics) spondylolysis in athletes.