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Pelvic incidence effects pars interarticularis defect and spondylolisthesis

Year 2023, Volume: 4 Issue: 6, 651 - 655, 31.12.2023
https://doi.org/10.47582/jompac.1397370

Abstract

Aims: Pars interarticularis defect (PID) is a common problem in society and may be accompanied with low back pain and radiculopathy. Magnetic resonance imaging (MRI) can detect it with high sensitivity. If left untreated, it may progress to spondylolisthesis. In this study, we wanted to emphasize the importance of the pelvic incidence (PI) angle in terms of following the development of spondylolisthesis after PID by examining the relationship between PID and spondylolisthesis and PI.
Methods: 118 patients who applied to Şanlıurfa Training and Research Hospital between 2021-2022 and underwent lumbar MRI were included in the study. The criteria for inclusion of patients in the study were the detection of a pars interarticularis defect on MRI, the ability to be evaluated by direct radiography or CT, and the ability to monitor the femoral head and sacrum in a way that PI could be measured. PI angle measurement was performed, confirmed by CT. The relationship between PID, spondylolisthesis and PI was examined.
Results: Of the 118 patients participating in the study, 77 (65.3%) were women and 41 (34.7%) were men. Pars defect was most commonly seen at the L5 level (67.8%). The average pelvic incidence angle is 64.2±8.6. Half of the patients were calculated as Meyerding grade 0 and 95.8% were treated medically. The median pelvic incidence angle value of patients without spondylolisthesis was found to be 58.0, the median pelvic incidence angle value of patients with a Meyerding grading of one was found to be 68.0, and the median value of the pelvic incidence angle of patients with a Meyerding grading of one was found to be 78.0 (p<0.001).
Conclusion: In this study, we detected patients with PID with MRI and revealed that there is a significant relationship between high PI degree and PID and spondylolisthesis. When high PI is detected in patients with PID, predicting that spondylolisthesis may develop in these patients is an important finding that will shape follow-up and treatment.

Ethical Statement

The study was approved by the Şanlıurfa Harran University(Date:2023) and because the study was designed retrospectively, no written informed consent form was obtained from patients.

References

  • Linton AA, Hsu WK. a review of treatment for acute and chronic pars fractures in the lumbar spine. Curr Rev Musculoskelet Med. 2022;15(4):259-271.
  • Berger RG, Doyle SM. Spondylolysis 2019 update. Curr Opin Pediatr. 2019;31(1):61-68.
  • Sakai T, Goda Y, Tezuka F, et al. Clinical features of patients with pars defects identified in adulthood. Eur J Orthop Surg Traumatol. 2016;26(3):259-262.
  • Saifuddin A, White J, Tucker S, Taylor BA. Orientation of lumbar pars defects: implications for radiological detection and surgical management. J Bone Joint Surg Br. 1998;80(2):208-211.
  • Goda Y, Sakai T, Sakamaki T, Takata Y, Higashino K, Sairyo K. Analysis of MRI signal changes in the adjacent pedicle of adolescent patients with fresh lumbar spondylolysis. Eur Spine J. 2014;23(9):1892-1895.
  • Sairyo K, Katoh S, Takata Y, et al. MRI signal changes of the pedicle as an indicator for early diagnosis of spondylolysis in children and adolescents: a clinical and biomechanical study. Spine. 2006;31(2):206-211.
  • Labelle H, Roussouly P, Berthonnaud E, Dimnet J, O'Brien M. The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine. 2005;30(6S):S27-34.
  • Rajnics P, Templier A, Skalli W, Lavaste F, Illés T. The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord Tech. 2002;15(1):24-30.
  • Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. 1984;66(5):699-707.
  • Micheli LJ, Wood R. Back pain in young athletes. significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med. 1995;149(1):15-18.
  • Sakai T, Sairyo K, Takao S, Nishitani H, Yasui N. Incidence of lumbar spondylolysis in the general population in Japan based on multidetector computed tomography scans from two thousand subjects. Spine. 2009;34(21):2346-2350.
  • Park JS, Moon SK, Jin W, Ryu KN. Unilateral lumbar spondylolysis on radiography and MRI: emphasis on morphologic differences according to involved segment. AJR Am J Roentgenol. 2010;194(1): 207-215.
  • Sakai T, Sairyo K, Mima S, Yasui N. Significance of magnetic resonance imaging signal change in the pedicle in the management of pediatric lumbar spondylolysis. Spine. 2010;35(14):E641-E645.
  • Rush JK, Astur N, Scott S, Kelly DM, Sawyer JR, Warner Jr WC. Use of magnetic resonance imaging in the evaluation of spondylolysis. J Pediatr Orthop. 2015;35(3):271-275.
  • Saifuddin A, Burnett SJ. The value of lumbar spine MRI in the assessment of the pars interarticularis. Clin Radiol. 1997;52(9):666-671.
  • Masci L, Pike J, Malara F, Phillips B, Bennell K, Brukner P. Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis. Br J Sports Med. 2006;40(11):940-946.
  • Bhalla A, Bono CM. Isthmic lumbar spondylolisthesis. Neurosurg Clin N Am. 2019;30(3):283-290.
  • Cavalier R, Herman MJ, Cheung EV, Pizzutillo PD. Spondylolysis and spondylolisthesis in children and adolescents: I. Diagnosis, natural history, and nonsurgical management. J Am Acad Orthop Surg. 2006;14(7):417-424.
  • Danielson BI, Frennered AK, Irstam LK. Radiologic progression of isthmic lumbar spondylolisthesis in young patients. Spine. 1991;16(4):422-425.
  • Wiltse LL. The etiology of spondylolisthesis. J Bone Joint Surg Am. 1962;44(3):539-560.
  • Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998;7(2):99-103.
  • Hanson DS, Bridwell KH, Rhee JM, Lenke LG. Correlation of pelvic incidence with low- and high-grade isthmic spondylolisthesis. Spine. 2002;27(18):2026-2029.

Pars interartikülaris defekti, spondilolistezis ve pelvik insidans ilişkisi

Year 2023, Volume: 4 Issue: 6, 651 - 655, 31.12.2023
https://doi.org/10.47582/jompac.1397370

Abstract

AMAÇ: Pars interartikülaris defekti (PİD) toplumda sık görülen, bel ağrısı ve radikülopati ile
seyredebilen bir problemdir. Manyetik rezonans görüntüleme (MRG) yüksek duyarlılıkla
saptayabilmektedir. Tedavi edilmediği durumlarda spondilolistezise ilerleyebilir. Bu
çalışmada PİD ve spondilolistezis ile pelvik insidans (Pİ) arasındaki ilişkiyi inceleyerek, PİD
sonrası spondilolistezis gelişmesini takip etmek açısından Pİ açısının önemini vurgulamak
istedik.
GEREÇ VE YÖNTEM: Şanlıurfa Eğitim ve Araştırma hastanesine 2021-2022 yılları arasında
başvuran ve lomber MRG yapılan 118 hasta çalışmaya dahil edildi. MRG’de pars
interartikülaris defekti saptanması, aynı zamanda direk radyografi veya BT ile
değerlendirilebiliyor olması, Pİ ölçümü yapılabilecek şekilde femur başı ve sakrumun
izlenebilmesi hastaların çalışmaya dahil edilme kriterlerini oluşturdu. BT ile doğrulanarak Pİ
açısı ölçümü yapıldı. PİD, spondilolistezis ve Pİ arasındaki ilişki incelendi.
BULGULAR: Çalışmaya katılan 118 hastanın 77(%65,3)’si kadın 41(34,7)’i erkekti. Pars
defekti en sık L5 seviyesinde görülmüştür (%67,8). Pelvik insidans açısı ortalama
64,2±8,6’dır. Hastaların yarısı Meyerding evre 0 olarak hesaplanmıştır ve %95,8’i medikal
olarak tedavi edilmiştir. Spondilolistezis olmayan hastaların pelvik insidans açı ortanca değeri
58,0, Meyerding evrelemesi bir olan hastaların pelvik insidans açı ortanca değeri 68,0, ikinin
üzerinde olanların ise 78,0 olarak saptanmıştır (p<0,001)
SONUÇ: Biz bu çalışmada MRG ile PİD olan hastaları tespit ederek, yüksek Pİ derecesi ile
PİD ve spondilolistezis arasında anlamlı bir ilişki olduğunu ortaya koyduk. PİD saptanan
hastalarda yüksek Pİ saptandığında, bu hastalarda spondilolistezis gelişebileceğini öngörmek
takip ve tedaviyi şekillendirecek önemli bir bulgudur.

References

  • Linton AA, Hsu WK. a review of treatment for acute and chronic pars fractures in the lumbar spine. Curr Rev Musculoskelet Med. 2022;15(4):259-271.
  • Berger RG, Doyle SM. Spondylolysis 2019 update. Curr Opin Pediatr. 2019;31(1):61-68.
  • Sakai T, Goda Y, Tezuka F, et al. Clinical features of patients with pars defects identified in adulthood. Eur J Orthop Surg Traumatol. 2016;26(3):259-262.
  • Saifuddin A, White J, Tucker S, Taylor BA. Orientation of lumbar pars defects: implications for radiological detection and surgical management. J Bone Joint Surg Br. 1998;80(2):208-211.
  • Goda Y, Sakai T, Sakamaki T, Takata Y, Higashino K, Sairyo K. Analysis of MRI signal changes in the adjacent pedicle of adolescent patients with fresh lumbar spondylolysis. Eur Spine J. 2014;23(9):1892-1895.
  • Sairyo K, Katoh S, Takata Y, et al. MRI signal changes of the pedicle as an indicator for early diagnosis of spondylolysis in children and adolescents: a clinical and biomechanical study. Spine. 2006;31(2):206-211.
  • Labelle H, Roussouly P, Berthonnaud E, Dimnet J, O'Brien M. The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine. 2005;30(6S):S27-34.
  • Rajnics P, Templier A, Skalli W, Lavaste F, Illés T. The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord Tech. 2002;15(1):24-30.
  • Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. 1984;66(5):699-707.
  • Micheli LJ, Wood R. Back pain in young athletes. significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med. 1995;149(1):15-18.
  • Sakai T, Sairyo K, Takao S, Nishitani H, Yasui N. Incidence of lumbar spondylolysis in the general population in Japan based on multidetector computed tomography scans from two thousand subjects. Spine. 2009;34(21):2346-2350.
  • Park JS, Moon SK, Jin W, Ryu KN. Unilateral lumbar spondylolysis on radiography and MRI: emphasis on morphologic differences according to involved segment. AJR Am J Roentgenol. 2010;194(1): 207-215.
  • Sakai T, Sairyo K, Mima S, Yasui N. Significance of magnetic resonance imaging signal change in the pedicle in the management of pediatric lumbar spondylolysis. Spine. 2010;35(14):E641-E645.
  • Rush JK, Astur N, Scott S, Kelly DM, Sawyer JR, Warner Jr WC. Use of magnetic resonance imaging in the evaluation of spondylolysis. J Pediatr Orthop. 2015;35(3):271-275.
  • Saifuddin A, Burnett SJ. The value of lumbar spine MRI in the assessment of the pars interarticularis. Clin Radiol. 1997;52(9):666-671.
  • Masci L, Pike J, Malara F, Phillips B, Bennell K, Brukner P. Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis. Br J Sports Med. 2006;40(11):940-946.
  • Bhalla A, Bono CM. Isthmic lumbar spondylolisthesis. Neurosurg Clin N Am. 2019;30(3):283-290.
  • Cavalier R, Herman MJ, Cheung EV, Pizzutillo PD. Spondylolysis and spondylolisthesis in children and adolescents: I. Diagnosis, natural history, and nonsurgical management. J Am Acad Orthop Surg. 2006;14(7):417-424.
  • Danielson BI, Frennered AK, Irstam LK. Radiologic progression of isthmic lumbar spondylolisthesis in young patients. Spine. 1991;16(4):422-425.
  • Wiltse LL. The etiology of spondylolisthesis. J Bone Joint Surg Am. 1962;44(3):539-560.
  • Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998;7(2):99-103.
  • Hanson DS, Bridwell KH, Rhee JM, Lenke LG. Correlation of pelvic incidence with low- and high-grade isthmic spondylolisthesis. Spine. 2002;27(18):2026-2029.
There are 22 citations in total.

Details

Primary Language English
Subjects Brain and Nerve Surgery (Neurosurgery)
Journal Section Research Articles [en] Araştırma Makaleleri [tr]
Authors

Atakan Besnek 0000-0001-6579-6976

Publication Date December 31, 2023
Submission Date November 28, 2023
Acceptance Date December 15, 2023
Published in Issue Year 2023 Volume: 4 Issue: 6

Cite

AMA Besnek A. Pelvic incidence effects pars interarticularis defect and spondylolisthesis. J Med Palliat Care / JOMPAC / jompac. December 2023;4(6):651-655. doi:10.47582/jompac.1397370

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Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]



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