Spondylolysis in the past: A case study of hunter-gatherers from Southern Patagonia.

Spondylolysis is a fracture of the pars interarticularis, the portion of the neural arch that lies between the superior articular facets and the inferior articular facets. Clinical evidence has suggested repetitive trauma to be the most probable cause, even though morphological weakness of the vertebra is probably also involved. Prevalence is between 3% and 8% in modern populations, while in archaeological samples it varies from 0% to 71.4%. Considering that very little data about this condition is available in past populations from the southern extreme of South America, the aim of this paper is to analyze the spondylolysis in a human skeletal sample from Southern Patagonia and, at the same time, to explore the prevalence of spondylolysis in archaeological contexts around the world to gain a better understanding of the results presented here. The Southern Patagonian skeletal series analyzed here showed a prevalence of 20%, with lower prevalence in the pre contact sample (11.1%) than in the contact period (23.1%). Skeletons from the Salesian Mission "Nuestra Señora de La Candelaria" showed a higher prevalence (25%) than the sample of skeletal remains recovered from outside the mission (20%), suggesting that changes in lifestyle of hunter-gatherers during contact could be implicated in the development of spondylolysis in this sample. A worldwide survey displays a wide range of prevalence figures in American and Asian samples and low diversity between African and European populations. Hunter-gatherers from Southern Patagonia showed similar values to those observed in other American samples.

Acute lumbar spondylolysis in intercollegiate athletes.

STUDY DESIGN: A retrospective case series. OBJECTIVE: The purpose of this study was to describe a unique group of intercollegiate athletes who are skeletally mature and who developed symptomatic acute lumbar spondylolysis and to study long-term return to play outcome of nonoperative and surgical repair of L3 and L4 spondylolysis in skeletally mature athletes. BACKGROUND: Traditionally, symptomatic acute lumbar spondylolysis is a defect found in skeletally immature athletes, most commonly in the pars interarticularis of L5, less commonly in the L3/L4 region, and even less commonly in skeletally mature athletes as described in this group. METHODS: Eight intercollegiate athletes (2 women and 6 men, ages ranging from 19 to 21 y) with acute lumbar spondylolysis were diagnosed by means of computed tomography (CT) and single photon emission-CT bone scan. L3 lesions were present in 5 patients, and L4 lesions were present in 3 patients. All patients were treated initially nonoperatively with a protocol of bracing and activity modification. The healing progress was assessed through repeat CT scan. Patients who failed to respond to nonoperative procedures underwent direct repair of their pars defect through variable angle pedicle screw and sublaminar hook. Outcomes were measured by completion of the Oswestry Low Back Pain Disability Questionnaire (mean follow-up 6.5 y) and return to athletic participation. RESULTS: All patients successfully returned to full athletic competition. Two patients showed radiographic healing and resolution of pain following 3 months of nonoperative treatment. Five patients required surgical repair of the pars defect. All of these patients eventually returned to unrestricted participation in athletics. CONCLUSIONS: This study shows that this subgroup will generally respond well to surgical correction of the pars defect and return to uninhibited competition following conservative treatment and/or surgical repair.

Intersegmental sagittal motion in the lower cervical spine and discogenic spondylosis: a preliminary study.

OBJECTIVE: The object of this investigation was to identify any correlation between discogenic spondylosis and the type of motion (normal, hypomobility, hypermobility, paradoxical motion) found in the sagittal plane of the intervertebral motion units of the lower cervical spine. DESIGN AND SETTING: A case control study was performed from the files of 100 patients (ages 15-73) with cervical spine-related symptomatology at the Anglo-European College of Chiropractic Clinic. PATIENTS: The cases were randomly selected from a cohort of patients with normal radiographic anatomy who attended the clinic from 1987-1990 and were known to have cervical spine neutral, flexion and extension lateral radiographs taken. MAIN OUTCOME MEASURES: Extended chi 2 was used to test the observed data. RESULTS: The findings from both the flexion and extension films suggested that intervertebral motion units with and without varying severities of discogenic spondylosis did differ with respect to the type of motion exhibited there (flexion: chi 2 = 39.399, p < .001; extension: chi 2 = 45.7424, p < .001). Intervertebral motion units which had discogenic spondylosis had a greater likelihood of exhibiting motion abnormalities (flexion: chi 2 = 5.665, p < .01; extension: chi 2 = 6.178, p < .01), and all types of motion seemed to be dependent on its severity (flexion: chi 2 = 16.464, p < .01; extension: chi 2 = 15.954, p < .02). In general, normal motion occurred approximately 60% of the time when there was absent or mild discogenic spondylosis and decreased precipitously as moderate and severe amounts of discogenic spondylosis appeared. In global cervical flexion, when there was either little or no discogenic spondylosis and abnormal motion was present, intersegmental hypermobility was predominant. Hypomobility became predominant overall as moderate and severe discogenic spondylosis was found. In global cervical extension, for all severities of discogenic spondylosis when there was abnormal motion, intersegmental hypomobility was predominant. Also of note was the presence of paradoxical motion, which occurred in 11% of the intervertebral motion units without discogenic spondylosis [usually at the C7-T1 intervertebral motion unit (86%)]. CONCLUSIONS: From the data it can be concluded that there are trends which occur with differing amounts of discogenic spondylosis when considering intersegmental cervical sagittal motion. However, additional detailed study is required to corroborate the findings and determine what their clinical significance is.

Variations in the prevalence of spondylolysis in early British populations.

Crude prevalence rates of spondylolysis were estimated in skeletal populations from various periods. There was a steady increase in prevalence from 3.74% in Romano-British to 5.08% in medieval populations, but the rate fell considerably to 1.42% in a population from an 18th/19th century context. This trend was not statistically significant, however. The male/female ratio was approximately unity until the 18th/19th century when the expected male excess appeared. The lesions predominantly affected L5 and all were isthmic in type. Of the total of 52 cases, only four were unilateral. One occurred in the fourth cervical vertebra. There were few complications; spondylolisthesis was noted in four cases and in three there were osteoarthritic changes on the superior margin of the displaced lamina.

Spondylolysis and its relationship to degenerative joint disease in the prehistoric southeastern United States.

Spondylolysis, a fatigue fracture in the neural arch of lumbar vertebrae, is common in Eskimos and some athletes. In Archaic Indians from northwestern Alabama, 17% of males and 20% of females with complete lumbar regions showed this defect. It is found at a fairly early age in adult males in this group, but in females it does not appear until after age 40 years. Spondylolysis is associated with higher levels of osteoarthritis around the fifth lumbar vertebra, where this defect typically occurs. Otherwise, there is little relationship between its presence and degenerative joint disease, especially in the weight-bearing joints. The incidence in young males may be related to activities necessitating a high level of mobility around the lumbar spine. The late occurrence in females suggests that osteoporosis may have been a contributing factor.