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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The defect in the pars interarticularis in spondylolysis and spondylolisthesis is most often the result of repeated trauma, stress, and factors other than acute fracture. These fatigue fractures develop early in life, may have a strong hereditary basis, and most often represent incidental roentgenographic findings. Attention should be given to the youngster or adolescent with low-back pain and paraspinal muscle spasm. If these patients are followed closely, the incidence of pars interarticularis defect is higher than appreciated. The lesion in some of these individuals may progress to significant vertebral slipping. If the developing defect is recognized early, treatment can be quite satisfactory.
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PMID:Fatigue fracture: the basic lesion is inthmic spondylolisthesis. 112 67

Histologic findings of 4 cases of spondylolysis and spondylolisthesis in childhood and their pathogenetic interpretation. The microscopic changes in the lateral gap of the vertebral arch in children are explained as due to stress in the growing intervertebral bones, as fatigue fractures in the widest sense, with a tendency to pathologic union and fibro-cartilagineous pseudarthrosis. During pathogenesis we distinguish between the "primary lysis", a stage of repair followed by defective healing and the resulting spondylolysis.
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PMID:[Morbid anatomy and pathogenesis of spondylolysis and spondylolysthesis in childhood (author's transl)]. 127 94

Anterior displacement in spondylolisthesis is a slow process. The forces contributing to anterior shear arise from the vertical load on the spine above the lesion, from activity in the muscles of the spine and trunk, and from the effects of movements. The shear is normally resisted by the annulus fibrosus, compression of the facets at the apophyseal joints, and by tension in the anterolateral layers of cortical bone in the pars interarticularis. The anterior shear-strength of the disk is not known though Cyron and Hutton have shown that it is a major contributor to the total stiffness; in the early stages of spondylolysis it provides the only resistance. The capacity of the pars for resisting tensile forces anteriorly has been studied in tests of single vertebrae in which posterior forces were applied to the inferior articular processes. Forces at failure at L4 and L5 have been reported at up to 2500 N by Cyron et al. and up to 5800 N by Lamy et al. with means of 1800 N and 3200 N respectively. The mean posterior displacement of the inferior facets reported by Cyron et al. was 6.5 mm at failure. Too little is known of the mechanical factors in the etiology of spondylolysis for a definition of the postures and movements of the body which put the lumbar neural arch at greatest risk. While a combination of fatigue-failure and high strain-rate of forces induced in extended postures seems likely, further investigations are needed to elucidate the pathogenesis in many cases.
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PMID:Mechanical factors in spondylolisthesis and spondylolysis. 127 87

There are 2 fairly common types of spondylolisthesis in children - dysplastic and isthmic. The dysplastic type is secondary to congenital defects at the lumbosacral joint. The isthmic is usually due to a fatigue fracture of the pars interarticularis but there is also an hereditary element in this type. Most children with spondylolisthesis never develop significant symptoms and even of those who do, the vast majority can be treated without surgery. If symptoms persist or if further olisthesis is occurring, a one-level spinal fusion done through a paraspinal approach is recommended. It is most important not to allow olisthesis to develop to the point that the child shows the cosmetically undesirable stigmata characteristic of the condition. Solid fusion can be obtained in every case and will stop further slip.
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PMID:Treatment of spondylolisthesis and spondylolysis in children. 127 90

The postoperative radiographs of 48 patients who underwent posterolateral in situ fusion for spondylolysis and Grade 1 or less spondylolisthesis over an 11-year period showed healing of the pars defects in 90% of the cases. The patients who showed healing had an average preoperative duration of symptoms of 17 months (mean, 12 months). The five patients whose radiographs showed persistent defects postoperatively were found to have had preoperative symptoms for an average of 47 months (mean, 48 months). This significantly greater (P 0.05) duration of symptoms prior to stabilization was the only variable that proved to be statistically significant. Controversy continues to exist as to the etiology of spondylolysis; however, the ability to heal the defect with lumbar spinal stability certainly supports the theory that the defect is a result of fatigue stresses, which finally manifest as a fracture seen on radiographs as the spondylolytic defect. Posterior spinal stabilization in those patients with symptoms for a period of less than 2 years who have failed conservative management can be expected to heal the pars defects.
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PMID:Postoperative radiographic evidence for fatigue fracture as the etiology in spondylolysis. 261 64

Fourteen patients with degenerative spondylolisthesis and three patients with degenerative scoliosis, all of whom experienced low-back pain, lumbar radiculopathy, and/or intermittent claudication were treated with posterolateral fusion and correction of deformities using a new instrumentation system. This new spinal fixation system combines the advantages of a rod for scoliotic deformities and a plate for sagittal plane disorders. The combination rod-plates can apply multiple forces to facilitate correction of complex deformities as well as enable indirect neurologic decompression. The system allows segmental rigid fixation via transpedicular screws that is limited only to the abnormal vertebral levels to preserve the maximum number of uninvolved lumbar motion segments. The physiologic lumbar lordotic curvature is also preserved. The minimum follow-up period was 1 year. Satisfactory results were obtained in 15 patients (88%). No intraoperative complications occurred. Screw fatigue occurred in two patients at 1-year follow-up examination with no sequelae. The scoliotic and spondylolisthetic deformities were reduced significantly in all patients. This method appears to assist in reducing pathologic motion and deformities that contribute to low-back pain. Compression on neural structures is relieved by thorough decompression and distraction; spinal canal anatomy is also restored.
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PMID:Degenerative spondylolisthesis and degenerative scoliosis treated with a combination segmental rod-plate and transpedicular screw instrumentation system: a preliminary report. 298 Feb 52

Acute traumatic bilateral spondylolysis and spondylolisthesis was observed in a 34-year-old man. The literature on pathologic and biomechanical factors leading to acute fracture of the pars interarticularis emphasizes the importance of distinguishing spondylolysis resulting from acute trauma from the more common lytic-fatigue pars defect.
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PMID:Acute traumatic spondylolysis. Report of a case and review of the literature. 328 75

The repeated minor stress of sport can produce a fatigue fracture of the neural arch. A case of unilateral spondylolysis progressing to bilateral defects and developing spondylolisthesis is described. A review of the literature is presented and the aetiology of spondylolysis is discussed.
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PMID:Traumatic spondylolysis--a case report. 361 31

Radiographs were obtained of the lumbosacral spines of 143 patients that had never walked. The frequency of spondylolysis and spondylolisthesis was determined, as well as that of other spinal abnormalities. The average age of the patients was 27 years, with a range of 11 to 93 years. The underlying diagnoses responsible for the nonambulatory status varied, but cerebral palsy predominated. No case of spondylolysis or spondylolisthesis was detected, and when compared to the 5.8% incidence in the general population, this finding is significant at the P less than 0.001 level. The incidences of spinal bifida (8.4%) and of transitional vertebrae (10.9%) are similar to those found in the general population. Scoliosis was found in 49% and vertebral body height was increased in 32.9%. Degenerative changes occurred in only 2.8%. These results support the theory that spondylolysis and isthmic spondylolisthesis represent a fatigue fracture resulting from activities associated with ambulation.
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PMID:The incidence of spondylolysis and spondylolisthesis in nonambulatory patients. 720 72

Between 1923 and 1976, 312 posterior spinal fusions using the methods of Albee, Bosworth and Hibbs were performed on patients with spondylolisthesis at the Orthopaedic University Hospital Balgrist, Zurich. Long-term clinical results were rated as good in 80% of all patients operated on with the Albee method. The results after the Hibbs procedure on the other hand was good in only 65%. Progressive vertebral slipping after operation was seen in about 60% of all patients operated on by Albee's method, particularly in cases with severe spondylolisthesis. This slipping stops as soon as the intervertebral space had fused. Relief of the subjective symptoms also occured at this time. This phenomenon was only rarely seen after the Hibbs operation, in which the better postoperative stability leads to sclerosis of the discs indicating degenerative changes without a significant decrease in the disc height. The greater stability of the Hibb's fusion is more easily overstressed by body movements which can cause persistent symptoms and later lead to fatigue fractures.
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PMID:A comparison of the long term results of three types of posterior fusion of the lumbar spine for spondylolisthesis. 734 14


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