Conservative treatment for pediatric lumbar spondylolysis to achieve bone healing using a hard brace: what type and how long?

Clinical article

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Object

Various kinds of trunk braces have been used to achieve bone healing in cases of pediatric lumbar spondylolysis. However, the optimal brace for achieving bone healing is unclear. The purpose of the present study was to determine in what types of spondylolysis bone healing can be achieved and how long it takes.

Methods

In this prospective study, 63 pars interarticularis defects (spondylolysis) among 37 patients who were younger than 18 years (mean 13.5 ± 2.7 years) were treated using a hard brace. The youngest patient was 8 years old. Based on the results of CT scanning, the lyses were classified into 3 categories: early, progressive, and terminal defects. Progressive defects were further divided into 2 types according to STIR MRI findings: those with high signal intensity at the adjacent pedicle and those with low signal intensity (that is, a normal appearance). A hard brace, such as a molded plastic thoracolumbosacral orthosis, was used to immobilize the trunk. Approximately every 3 months, CT scanning was performed to evaluate bone healing until approximately 6 months.

Results

The union rates were 94%, 64%, 27%, and 0% for the early, progressive with high signal intensity, progressive with low signal intensity, and terminal defects, respectively. It was noted that no terminal defect was healed using conservative treatment. The mean time to healing among the defects that showed bone healing was 3.2, 5.4, and 5.7 months for the early, progressive with high signal intensity, and progressive with low signal intensity groups, respectively.

Conclusions

Patients with early-stage defects are the best candidates for conservative treatment with a hard brace because more than 90% of such cases can be healed in 3 months.

Article Information

Address correspondence to: Koichi Sairyo, M.D., Ph.D., Department of Orthopaedic Surgery, University of Teikyo, Mizonokuchi Hospital, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa 213-8507, Japan. email: sairyokun@hotmail.com.

Please include this information when citing this paper: published online April 20, 2012; DOI: 10.3171/2012.2.SPINE10914.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Photographs showing a hard trunk brace. This brace holds the rib cage and pelvis to restrict lumbar rotation as well as extension.

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    The STIR MRI study showing a high signal change at the adjacent pedicle. The left pedicle shows high signal intensity (arrow), whereas the right pedicle does not.

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    Images illustrating the classification by CT scanning according to Fujii et al. A hairline fracture can be seen in the early stage (A), a clear bone gap is apparent in the progressive stage (B), and pseudarthrosis occurs at the terminal stage (C).

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    Case 1. Images obtained in a 13-year-old boy who played soccer. Left unilateral spondylolysis at L-5 was diagnosed on CT scanning. A T2-weighted MRI study shows high signal intensity at the pedicle adjacent to the defect. After 6 months of conservative treatment using the hard brace as well as not participating in sports activities, bone healing is achieved.

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    Case 2. Images obtained in a 14-year-old girl who played volleyball. At presentation, bilateral progressive defects were noted on CT at L-4 (left). On T2-weighted MRI, there was no marrow edema adjacent to the defects, indicated by low signal intensity. The patient was asked to wear the hard brace and not to take part in sports activities. After 7 months, bone healing of both defects was achieved (right).

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