Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study.
BACKGROUND
Unilateral spondylolysis is common in youths; its clinical and biomechanical features, especially effects on the contralateral side, are not fully understood.


OBJECTIVE
Unilateral spondylolysis predisposes the contralateral side to stress fracture, especially in athletes actively engaged in sporting activities involving torsion of the trunk.


METHODS
Case series and descriptive laboratory study.


METHODS
Thirteen athletes younger than age 20 with unilateral spondylolysis were included. The contralateral pedicle and pars of spondylolytic vertebrae were examined using computed tomography and magnetic resonance imaging. Using a finite element model of the intact ligamentous L3-S1 segment, stress distributions were analyzed in response to 400-N axial compression and 10.6-N.m moment in flexion, extension, lateral bending, and axial rotation. Unilateral spondylolysis was created in the model at L5. The stress results from the unilateral defect model were compared to the intact model predictions and correlated to the contralateral defects seen in patients.


RESULTS
Among 13 patients, there were 6 early-, 2 progressive-, and 5 terminal-stage defects. Three (23.1%) showed contralateral stress fracture. Among them, 2 belonged to the progressive-stage and 1 to the terminal-stage spondylolysis group. The remaining 4 patients in the terminal defect group showed stress reactions, such as sclerosis at the contralateral pedicle. In the finite element analysis model with an L5 left spondylolysis, the stresses at the contralateral and pars interarticularis were found to increase in all loading modes, with increases as high as 12.6-fold compared to the intact spine.


CONCLUSIONS
Unilateral spondylolysis could lead to stress fracture or sclerosis at the contralateral side due to an increase in stresses in the region.


CONCLUSIONS
Surgeons should be aware of possibility of contralateral stress fractures in cases in which patients, especially athletes engaged in active sports, show unilateral spondylolysis and persistent low back pain complaints.
Sairyo
Koichi
K
Department of Orthopedics, University of Tokushima, 3-18-15, Kuramoto, Tokushima 770-8503 Japan. sairyokun@hotmail.com
Katoh
Shinsuke
S
Sasa
Takahiro
T
Yasui
Natsuo
N
Goel
Vijay K
VK
Vadapalli
Sasidhar
S
Masuda
Akiyoshi
A
Biyani
Ashok
A
Ebraheim
Nabil
N
D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000209:etiology*; D001696:Biomechanical Phenomena; D002648:Child; D018450:Disease Progression; D005260:Female; D020342:Finite Element Analysis; D015775:Fractures, Stress / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D011859:Radiography; D013169:Spondylolysis / Q000150:complications* / Q000000981:diagnostic imaging