半谷美夏著:水泳における腰の外傷・障害の診断と治療. 宗田大編:復帰をめざすスポーツ整形外科. MEDICAL VIEW社 2011: 320-325.
Sairyo K, Sakai T, Yasui N.
Minimally invasive technique for direct repair of pars interarticularis defects in adults using a percutaneous pedicle screw and hook-rod system.
J Neurosurg Spine. 2009 May;10(5):492-5. doi: 10.3171/2009.2.SPINE08594.
Abstract/Text
In this report, the authors described a new minimally invasive technique to repair pars interarticularis defects in adults. The well-established technique using the pedicle screw (PS) and hook-rod system was modified. First, bilateral PSs were inserted percutaneuosly using the Sextant system. Then, through a small skin incision (3-4 cm), an illuminated tubular retractor (Quadrant system; Medtronic Sofamore Danek) was inserted into the pars defect. When this system is used, it is not necessary to detach all the back muscles to access the lytic part. The bursa and fibrocartilaginous mass near the defects were removed. After decortication of the pseudarthrosis at the spondylolytic level, bone grafts were implanted. Finally, the hook part of a hook-rod system was attached to the lamina and the rod was secured at the tulip head of the PSs. The authors performed this procedure in 2 adult patients, 32 and 24 years of age. Immediately after surgery both patients' low-back pain disappeared, and by 3 months postoperatively both had returned to their original work or sports activities.
Higashino K, Sairyo K, Katoh S, Sakai T, Kosaka H, Yasui N.
Minimally invasive technique for direct repair of the pars defects in young adults using a spinal endoscope: a technical note.
Minim Invasive Neurosurg. 2007 Jun;50(3):182-6. doi: 10.1055/s-2007-982511.
Abstract/Text
Pars defect (spondylolysis) of the lumbar spine can cause chronic low back pain, and it sometimes requires surgical intervention. Direct repair is selected for the surgery if young adult patients do not present significant disc degeneration and lumbar instability. In order to lessen damages of back muscles during surgery, we added the use of a spinal endoscope to the "Buck's screwing procedure" the direct repair. There are four steps in this procedure: 1) identification of the defect, 2) curettage (refresh) of the defect, 3) percutaneous insertion of the annulated screws and 4) cancellous bone grafting. All these steps can be done endoscopically. We treated 3 young adults--a baseball player, a professional cycle-racer and a sculptor--using this endoscopic procedure. There were no complications during or after the operation. Union was obtained in all defects within 3 months, and they returned to their previous activities within 6 months after the surgery.
Sairyo K, Katoh S, Sakamaki T, Komatsubara S, Yasui N.
A new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis. Technical note.
J Neurosurg. 2003 Apr;98(3 Suppl):290-3. doi: 10.3171/spi.2003.98.3.0290.
Abstract/Text
The authors describe a new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis. Short-term clinical outcome was evaluated. Surgery-related indications were: 1) radiculopathy without low-back pain; 2) no spinal instability demonstrated on dynamic radiographs; and 3) age older than 40 years. Seven patients, four men and three women, fulfilled these criteria and underwent endoscopic decompressive surgery. Their mean age was 60.9 years (range 42-70 years). No subluxation was present in four patients, whereas Meyerding Grade I slippage was demonstrated in three. For endoscopic decompression, a skin incision of 16 to 18 mm in length was made, and fenestration was performed to identify the affected nerve root. The proximal stump of the ragged edge of the spondylotic lesion, and the fibrocartilaginous mass compressing the nerve root were removed. The follow-up period ranged from 6 to 22 months (mean 11.7 months). Clinical outcome was evaluated using Gill criteria; in three patients the outcome was excellent, and in four it was good. This new endoscopic technique was useful in the decompression of nerve roots affected by spondylolysis, the technique was minimally invasive, and the clinical results were acceptable.
酒井紀典、西良浩一:成人腰椎分離症に対する分離部除圧および修復術の併用.整形外科 2011 62(8), 730-734.
Sairyo K, Katoh S, Ikata T, Fujii K, Kajiura K, Goel VK.
Development of spondylolytic olisthesis in adolescents.
Spine J. 2001 May-Jun;1(3):171-5. doi: 10.1016/s1529-9430(01)00018-3.
Abstract/Text
BACKGROUND CONTEXT: Although it has been well documented that slippage in patients with spondylolysis is most prevalent during the growth period, the exact time when slippage initiates and halts during the growth period is still unknown. Moreover, the contribution of spinal deformities, such as wedging of the vertebral body to the slippage, remains controversial.
PURPOSE: To clarify when slippage in pediatric spondylolysis initiates and halts.
STUDY DESIGN: Retrospective study.
PATIENT SAMPLE: We radiographically examined 46 athletes under 18 years of age with spondylolysis at the fifth lumbar vertebra (L5). The mean age at the first consultation was 13.3 years. The average follow-up period was 6.0 years.
OUTCOME MEASURES: Longitudinal observation of slippage at L5 on radiogram in correlation with the maturity of the lumbar spine.
METHODS: From a lateral radiogram of each patient, percent slippage, lumbar index (LI), and skeletal age of the affected vertebra were measured. Changes in the percent slippage over time were investigated, and the correlation between the percent slippage and LI was analyzed.
RESULTS: From the cartilaginous stage to the apophyseal stage, the slippage increased in 80.0% of the patients (16 of 20). From the cartilaginous stage to the epiphyseal stage, slippage increased in 11.1% of the patients (3 of 27). None of the patients (0 of 22) showed an increase after the epiphyseal stage. In 20 patients in whom slippage increased during the follow-up period, the percent slippage at the final consultation and the LI at the first consultation showed no significant correlation; however, the percent slippage and the LI at the final consultation were significantly (p<.01) correlated.
CONCLUSION: In conclusion, slippage was more prevalent in individuals of a younger skeletal age whose lumbar spine was immature, and it halted during the epiphyseal stage when the growth period was over and the vertebra matured. Furthermore, the results suggest that wedge deformity of an affected vertebra might be the result rather than the cause of slippage.
Takao S, Sakai T, Sairyo K, Kondo T, Ueno J, Yasui N, Nishitani H.
Radiographic comparison between male and female patients with lumbar spondylolysis.
J Med Invest. 2010 Feb;57(1-2):133-7. doi: 10.2152/jmi.57.133.
Abstract/Text
We studied the lumbar spines of 117 adults (39 women and 78 men) with spondylolysis unrelated to low back pain using multidetector computed tomography (CT). Of the 117 subjects with spondylolysis, including five with multiple-level spondylolysis, there were 124 vertebrae with spondylolysis. In adult lumbar spines with unilateral spondylolysis, there was no significant difference between the incidence of spondylolisthesis in female and male subjects. However, in those with bilateral spondylolysis, there was a significantly higher incidence of spondylolisthesis in female subjects (90.9%) than in males (66.2%). Furthermore, females with bilateral spondylolysis had significant more slippage than males. Lumbar index and lumbar lordosis were not significantly different between male and female subjects, and did not significantly correlate with slippage. In conclusion, to treat acute spondylolysis in adolescents, it is important to obtain bony union at least unilaterally, especially in female subjects, to prevent further slippage.
Sairyo K, Sakai T, Yasui N, Kiapour A, Biyani A, Ebraheim N, Goel VK.
Newly occurred L4 spondylolysis in the lumbar spine with pre-existence L5 spondylolysis among sports players: case reports and biomechanical analysis.
Arch Orthop Trauma Surg. 2009 Oct;129(10):1433-9. doi: 10.1007/s00402-008-0795-3. Epub 2008 Dec 16.
Abstract/Text
STUDY DESIGN: Case series and a biomechanical study using a finite element (FE) analysis.
OBJECTIVES: To report three cases with multi-level spondylolysis and to understand the mechanism biomechanically.
BACKGROUND: Multi-level spondylolysis is a very rare condition. There have been few reports in the literature on multi-level spondylolysis among sports players.
METHODS: We reviewed three cases of the condition, clinically. These patients were very active young sports players and had newly developed fresh L4 spondylolysis and pre-existing L5 terminal stage spondylolysis. Thus, we assumed that L5 spondylolysis may have increased the pars stress at the cranial adjacent levels, leading to newly developed spondylolysis at these levels. Biomechanically, we investigated pars stress at L4 with or without spondylolysis at L5 using the finite element technique.
RESULTS: L4 pars stress decreased in the presence of L5 spondylolysis, which does not support our first hypothesis.
CONCLUSIONS: It seems that multi-level spondylolysis may occur due to genetic and not biomechanical reasons.
西良浩一、酒井紀典著:小児・成長期における腰椎分離症選手のスポーツ復帰. 宗田大編:復帰をめざすスポーツ整形外科. MEDICAL VIEW社 2011: 594-600.