Clinical Outcome of Symptomatic Unilateral Stress Injuries of the Lumbar Pars Interarticularis.

Debnath, Ujjwal K. FRCS, MS(Orth); Freeman, Brian J. C. DM, FRCS(Tr & Orth); Grevitt, Michael P. FRCS, FRCS(Orth); Sithole, J PhD; Scammell, B E. FRCS(Orth), DM(Orth); Webb, John K. FRCS

The objective of this study was to evaluate the results of nonoperative and operative treatment of symptomatic unilateral lumbar pars stress injuries or spondylolysis.  42 patients (31 male, 11 female) with unilateral lumbar pars stress injuries or spondylolysis were included.  Patients with a positive stress reaction on single photon emission computerized tomography imaging underwent a strict protocol of activity restriction, bracing, and physical therapy for 6 months. At the end of 6 months, patients who remained symptomatic underwent a computed tomography (CT) scan to confirm the persistence of a spondylolysis. Eight patients subsequently underwent a direct repair of the defect using the modified Buck's Technique.  The authors conclude that the increased incidence of the unilateral lumbar pars stress injuries or frank defect on the contralateral side in a throwing sports, e.g., cricket (fast bowling), may be related to the hand dominance of the individual. Nonoperative treatment for patients with a unilateral lumbar pars stress injuries or spondylolysis resulted in a high rate of success, with 81% (34/42) of patients avoiding surgery. If symptoms persist beyond a reasonable period, i.e., 6 months, and reverse gantry CT scan confirms a nonhealing defect of the pars interarticularis, one may consider a unilateral direct repair of the defect with good functional outcome.

Spine.    32(9):995-1000, April 20, 2007.

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