title: Relationship between the histological findings of spondylolytic tissue, instability of the loose lamina, and low back pain.
abstract: METHODS
  We investigated the histomorphological features of the tissue occupying the spondylolytic defect (spondylolytic tissue), which was similar to ligament, and then graded the complete enthesis structure and the density of the fibrous portion. The relationships between the features, instability of the loose lamina against the affected vertebra, and the severity of low back pain were studied.
  
  
  OBJECTIVE
  To elucidate the histomorphological features of spondylolytic tissue and the associations between the features, instability of the loose lamina, and low back pain.
  
  
  BACKGROUND
  Spondylolysis is thought to be caused primarily by a fatigue fracture and spondylolytic tissue has been recognized as being a fibrocartilaginous mass. Recently, innervation of the spondylolytic tissue was reported to be one of the sources of low back pain.
  
  
  METHODS
  The spondylolytic tissue from 17 patients who underwent microscopic decompression of the pars defect was observed for histology including hematoxylin and eosin, elastica van Gieson, and immunohistochemical staining for S100 protein. Instability of the loose lamina against the affected vertebra was evaluated by flexion/extension radiographs.
  
  
  RESULTS
  The spondylolytic tissue had a ligamentous structure without innervation. The histomorphological findings, instability of the loose lamina, and low back pain had no relationship to one another.
  
  
  CONCLUSIONS
  Spondylolysis is a pseudarthorosis of the pars interarticularis and the spondylolytic tissue tends to develop noninnervated ligament-like tissue with an enthesis structure. The histomorphological features, instability of the loose lamina, and low back pain have no relationship to one another.
authors.affiliation: Department of Orthopaedic Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan. akiramchi@yahoo.co.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Miyauchi
authors.forename: Itsushi
authors.initials: I
authors.lastname: Baba
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Sumida
authors.forename: Hideki
authors.initials: H
authors.lastname: Manabe
authors.forename: Yuzou
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Ochi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013169:Spondylolysis / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery