• The Korean Journal of Pain
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• 제18권2호
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• pp.251-254
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• 2005

Spondylolysis, also known as stress injury of pars interarticularis, is a common cause of back pain in athletes, particularly children and young adults. Repeated minor traumas during flexion and extension of the spine are thought to result in bony failure due to excessive bone resorption. These lesions are common in the low back, with the majority found at the L5 vertebra. In the majority of cases of spondylolysis, non-operative treatments are recommended, such as NSAIDs, physiotherapy and bracing. Only if symptoms do not respond to conservative treatments should surgical intervention be considered. Recently, pars interarticularis injections for diagnostic and therapeutic purposes have been found to allow significant pain relief from spondylolysis for long periods. Here, the case of a 57-year-old man with spondylolysis, who suffered from back pain, which was not relieved by an epidural steroid injection, but in whom pars interarticularis injections of local anesthetic and steroid induced complete transient pain relief, following by moderate long-term relief, is presented.

• Journal of Korean Neurosurgical Society
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• 제49권6호
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• pp.351-354
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• 2011

Objective : This investigation was conducted to evaluate a new, safe entry point for the C2 pedicle screw, determined using the anatomical landmarks of the C2 lateral mass, the lamina, and the isthmus of the pars interarticularis. Methods : Fifteen patients underwent bilateral C1 lateral mass-C2 pedicle screw fixation, combined with posterior wiring. The C2 pedicle screw was inserted at the entry point determined using the following method : 4 mm lateral to and 4 mm inferior to the transitional point (from the superior end line of the lamina to the isthmus of the pars interarticularis). After a small hole was made with a high-speed drill, the taper was inserted with a 30 degree convergence in the cephalad direction. Other surgical procedures were performed according to Harm's description. Preoperatively, careful evaluation was performed with a cervical X-ray for C1-C2 alignment, magnetic resonance imaging for spinal cord and ligamentous structures, and a contrast-enhanced 3-dimensional computed tomogram (3-D CT) for bony anatomy and the course of the vertebral artery. A 3-D CT was checked postoperatively to evaluate screw placement Results : Bone fusion was achieved in all 15 patients (100%) without screw violation into the spinal canal, vertebral artery injury, or hardware failure. Occipital neuralgia developed in one patient, but this subsided after a C2 ganglion block. Conclusion : C2 transpedicular screw fixation can be easily and safely performed using the entry point of the present study. However, careful preoperative radiographic evaluation, regardless of methods, is mandatory.

• Journal of Korean Neurosurgical Society
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• 제51권1호
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• pp.14-19
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• 2012

Objective : The authors performed a retrospective study to assess the clinical and radiological outcome in symptomatic lumbar spondylolysis patients who underwent a direct pars repair surgery using two different surgical methods; pedicle screw with universal hook system (PSUH) and direct pars screw fixation (DPSF), and compared the results between two different treated groups. Methods : Forty-seven consecutive patients (PSUH; 23, DPSF; 15) with symptomatic lumbar spondylolysis who underwent a direct pars repair surgery were included. The average follow-up period was 37 months in the PSUH group, and 28 months in the DPSF group. The clinical outcome was measured using visual analogue pain scale (VAS) and Oswestry disability index (ODI). The length of operation time, the amount of blood loss, the duration of hospital stay, surgical complications, and fusion status were also assessed. Results : When compared to the DPSF group, the average preoperative VAS and ODI score of the PSUH group were less decreased at the last follow-up; (the PSUH group; back VAS : 4.9 vs. 3.0, leg VAS : 6.8 vs. 2.2, ODI : 50.6% vs. 24.6%, the DPSF group; back VAS : 5.7 vs. 1.1, leg VAS : 6.1 vs. 1.2, ODI : 57.4% vs. 18.2%). The average operation time was 174.9 minutes in the PSUH group, and 141.7 minutes in the DPSF group. The average blood loss during operation was 468.8 cc in the PSUH group, and 298.8 cc in the DPSF group. The average hospital stay after operation was 8.9 days in the PSUH group, and 7 days in the DPSF group. In the PSUH group, there was one case of a screw misplacement requiring revision surgery. In the DPSF group, one patient suffered from transient leg pain. The successful bone fusion rate was 78.3% in the PSUH group, and 93.3% in the DPSF group. Conclusion : The present study suggests that the technique using direct pars screw would be more effective than the method using pedicle screw with lamina hook system, in terms of decreased operation time, amount of blood loss, hospital stay, and increased fusion success rate, as well as better clinical outcome.

• The Journal of Korean Physical Therapy
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• 제15권4호
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• pp.24-33
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• 2003

Spondylolysis and spondylolisthesis are two conditions that directly involve changes in the vertebra. Spondylolysis is defined as a defect in the pars interarticularis, the region of the lamina between the superior and inferior articular facets. Progression of the defect can result in spondylolisthesis, which is defined as a subluxation or 'slippage' of two adjacent vertebrae. In the low back it occurs most commonly at the lumbosacral level; next in frequency is spondylolisthesis of the fourth lumbar vertebra on the fifth. To provide the reader with information about the aetiology and anatomical consideration of spondylolysis and spondylolisthesis type. Spondylolisthesis has recently been classified by Wiltse and others into five types based on the suspected aetiology; dysplastic, isthmic, degenerative, posttraumatic, pathologic and postsurgical. Of these five types, isthmic spondylolisthesi and degenerative spondylolisthesis, both of which are frequently associated with low back and lower limb pain.

• Annals of Rehabilitation Medicine
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• 제42권6호
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• pp.884-887
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• 2018

We report a female proband carrying a de novo 5q34-q35.2 deletion breakpoint, and review the unique skeletal phenotype and possible genotype related to this mutation. The patient presented with a persistent head tilt and limited head rotation. Non-contrast-enhanced three-dimensional computed tomography of the cervical spine revealed several malformations including a bone cleft in the right pars interarticularis, a bone defect in both C5 lamina and the transverse foramen at C2-C3, agenesis of the right articular process of C5, bony fusion of C4-C5, and subluxation of the craniocervical joints. Several deformities of the cervical spine seen in this patient have not been associated with the 5q deletion. A review of 5q-related mutations suggests that abnormalities associated with MSX2 gene might cause cervical spine abnormalities.

• 대한영상의학회지
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• 제81권3호
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• pp.644-653
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• 2020

목적 이 연구는 요추 후방감압술에서 발생한 후천적 척추분리증과 척추전방전위증의 다중검출 전산화단층촬영 소견에 대해 분석하고자 하였다. 대상과 방법 2003년부터 2017년까지 요추 후방감압술을 시행 받고 수술 전 및 수술 후 다중검출 전산화단층촬영을 촬영한 74명의 환자를 대상으로 하였다. 유합술을 시행하지 않은 1군과 유합술을 시행한 2군의 환자로 분류하였다. 수술 후 다중검출 전산화단층촬영 영상에서 요추 후방감압술의 크기, 척추분리증 또는 척추전방전위증 유무와 위치, 척추전방전위증의 유무, 후방관절 및 척추주위 근육의 지방 변화에 대해 분석하였다. 결과 후천적 척추분리증 또는 척추전방전위증의 빈도는 1군에서 20명 중 4명, 2군에서 54명 중 2명이였다. 후방감압술의 크기(%)는 전체 추궁판에 대한 추궁절제술의 크기를 백분율로 계산하였다. 요추 후방감압술의 크기(%)는 후천적 척추분리증 또는 척추전방전위증이 있는 경우 54.0 (1군)과 53.2 (2군)이었고, 후천적 척추분리증과 척추전방전위증이 없는 경우는 35.0(1군)이었다. 척추분리증의 위치는 1군에서는 후방감압술 분절의 후관절 부근에서 발생하며, 2군에서는 유합술 하방의 관절 간부에 발생하였다. 결론 다중검출 전산화단층촬영은 요추 후방감압술 이후 후천적 척추분리증과 척추전방전위증을 진단하는 데 유용하고, 후천적 척추분리증의 전형적인 위치를 잘 보여준다. 요추 후방감압술의 크기가 클수록 후천적 척추분리증과 척추전방전위증의 발생과 연관이 있었다.