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Pars interarticularis

Eleftherios Archavlis, Lucas Serrano, Eike Schwandt, Amr Nimer, Moisés Felipe Molina-Fuentes, Tamim Rahim, Maximilian Ackermann, Angelika Gutenberg, Sven Rainer Kantelhardt, Alf Giese
OBJECTIVE The goal of this study was to demonstrate the clinical and technical nuances of a minimally invasive, dorsolateral, tubular approach for partial odontoidectomy, autologous bone augmentation, and temporary C1-2 fixation to treat dens pseudarthrosis. METHODS A cadaveric feasibility study, a 3D virtual reality reconstruction study, and the subsequent application of this approach in 2 clinical cases are reported. Eight procedures were completed in 4 human cadavers. A minimally invasive, dorsolateral, tubular approach for odontoidectomy was performed with the aid of a tubular retraction system, using a posterolateral incision and an oblique approach angle...
September 30, 2016: Journal of Neurosurgery. Spine
Kevin Phan, Alexander E Dunn, Prashanth J Rao, Ralph J Mobbs
Lumbar disc herniation arises when the annulus fibrosus of the vertebral disc fails, thus allowing displacement of the nucleus pulposus and other tissue. The term far lateral is used variably in the literature and usually refers to an extraforaminal displacement in the peridiscal zone peripheral to the sagittal plane of the most lateral part of the pedicle at the same level. Non-surgical treatments of far lateral disc herniation include physical therapy, anti-inflammatory medication, and corticosteroid injections...
March 2016: J Spine Surg
E C Ang, A F Robertson, F A Malara, T O'Shea, J K Roebert, M E Schneider, A H Rotstein
OBJECTIVE: To compare the diagnostic accuracy of 3-T magnetic resonance imaging (MRI) with thin-slice 3D T1 VIBE sequence to 128-slice computer tomography (CT) in pars stress fractures of the lumbar spine. MATERIALS AND METHODS: 3-T MRI and CT of 24 patients involving 70 pars interarticularis were retrospectively reviewed by four blinded radiologists. The fracture morphology (complete, incomplete, or normal) was assessed on MRI and CT at different time points. Pars interarticularis bone marrow edema (present or absent) was also evaluated on MRI...
November 2016: Skeletal Radiology
Hyo-Sae Ahn, Whee Sung Son, Ji-Hoon Shin, Myun-Whan Ahn, Gun Woo Lee
STUDY DESIGN: Retrospective exploratory imaging study. PURPOSE: To investigate the significance of the coronal magnetic resonance imaging (MRI) using Proset technique to detect the hidden zone in patients with mid-zone stenosis by comparing with conventional axial and sagittal MRI and to explore the morphologic characteristic patterns of the mid-zone stenosis. OVERVIEW OF LITERATURE: Despite advancements in diagnostic modalities such as computed tomography and MRI, stenotic lesions under the pedicle and pars interarticularis, also called the mid-zone, are still difficult to definitely detect with the conventional axial and sagittal MRI due to its inherited anatomical peculiarity...
August 2016: Asian Spine Journal
Pierluigi Vergara
OBJECTIVE: Large schwannomas with intra- and extra-dural extension are often challenging surgical lesions. A variety of approaches, usually requiring large exposures, removal of facets and pars interarticularis and spinal stabilization, have been described so far. The aim of this study is to describe the "dual approach", a less invasive technique for the excision of such lesions. METHODS: A large intra- and extra- dural schwannoma with paraspinal extension (Eden type II) was removed via a unilateral approach - midline, pars and facet sparing and no supplemental instrumentation...
August 6, 2016: World Neurosurgery
Jia Min, Jian Wang, Zheng Feng Zhang, Wen Jie Zheng, Yue Zhou
STUDY DESIGN: Retrospective analysis of the clinical outcomes of eight patients with the lumbar pars interarticulars defects treated by direct repair with the aid of intraoperative O-arm based navigation and microendoscopic techniques. OBJECTIVE: To investigate the efficacy and safety of direct screw repair by using minimally invasive surgery for the lumbar pars interarticulars defects in a pilot study. SUMMARY OF BACKGROUND DATA: Direct repair of pars interarticulars defects has been used to treat young adult patients...
August 3, 2016: Spine
L Michael Kershen, Nicholas C Nacey, James T Patrie, Michael G Fox
PURPOSE: To determine the accuracy and short-term efficacy of fluoroscopy-guided steroid/anesthetic injections for symptomatic pars interarticularis (pars) defects. MATERIALS AND METHODS: Following IRB approval, all fluoroscopically guided pars injections from a single institution (6/2010 to 3/2016) were retrospectively and independently reviewed by two MSK radiologists. The radiologists evaluated the fluoroscopic images to determine if all of the pars injections associated with each procedure were intra-pars (n = 57 procedures; 106 pars injections), peri-pars (n = 3 procedures; three pars injected), or a combination of intra-pars and peri-pars (n = 6 procedures; 12 pars injected)...
October 2016: Skeletal Radiology
Jennifer A Reynolds, Joel D MacDonald
BACKGROUND: Acute complex C2 vertebral body fracture specifically does not involve the odontoid process or C2 pars interarticularis. External stabilization can be effective but may prolong healing and increase morbidity. Many traditional surgical techniques can achieve internal stabilization at the expense of normal cervical motion. We describe direct surgical C2 pedicle screw fixation as an option for managing acute complex C2 vertebral body fracture. CASE DESCRIPTION: Three patients were treated with direct pedicle screw fixation of acute traumatic complex C2 vertebral body fractures...
September 2016: World Neurosurgery
Fumitake Tezuka, Koichi Sairyo, Toshinori Sakai, Akira Dezawa
STUDY DESIGN: Case series. OBJECTIVE: The purpose of this paper is to present a case series of fresh stress fractures (spondylolysis) in the lumbar spines of adult athletes. SUMMARY OF BACKGROUND DATA: Lumbar spondylolysis is a stress fracture of the pars interarticularis, which is generally considered a disease of children or adolescence. There is only one case series written in English reporting on adult-onset fresh spondylolysis. METHODS: Eleven patients aged 20-27 years are included in this case series...
June 20, 2016: Clinical Spine Surgery
Masahiro Morita, Akira Miyauchi, Shinya Okuda, Takenori Oda, Motoki Iwasaki
STUDY DESIGN: A case series study. OBJECTIVE: To investigate the electrophysiological location of nerve root entrapment in patients with isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA: Although the lesion of the nerve root in patients with isthmic spondylolisthesis has been thought to be located at the pars interarticularis due to proliferation of fibrous cartilage, there is no electrophysiological study in relation to this accomplished fact...
June 3, 2016: Clinical Spine Surgery
Kevin J Lawrence, Tim Elser, Ryan Stromberg
INTRODUCTION: Spondylolysis is a common occurrence for adolescent athletes who have low back pain. The injury involves a defect in the pars interarticularis, occurring as a result of repeated hyperextension and rotation. CLINICAL PRESENTATION: Clinical findings might include tightness of the hip flexors and hamstrings, weakness of the abdominals and gluteals, and an excessive lordotic posture. The validity of several clinical tests were compared alongside magnetic resonance imaging, but were not able to distinguish spondylolysis from other causes of low back pain...
July 2016: Physical Therapy in Sport
Matthew J Goldstein, James Bruffey, Robert K Eastlack
STUDY DESIGN: Case report OBJECTIVE.: To report a case of direct pars osteosynthesis using computed topography (CT) navigation, image guided cortically-placed screws with curvilinear subspinous modular link. SUMMARY OFBACKGROUND DATA: Spondylolysis fracture is commonly encountered in athletes who subject their spines to repetitive hyperextension stress. Initial treatment is non-operative, consisting of rest, activity modification, physical therapy, and/or bracing...
April 19, 2016: Spine
Rafid Al-Mahfoudh, Christopher Beagrie, Ele Woolley, Rasheed Zakaria, Mark Radon, Simon Clark, Robin Pillay, Martin Wilby
Study Design Retrospective study of a prospectively maintained database. Objective Our aim was to retrospectively review management and outcomes of patients with low-grade hangman's fractures, specifically looking at differences in outcomes between collars and halo immobilization. We also studied fracture patterns and their treatment outcomes. Methods Forty-one patients with hangman's fractures were identified from 105 patients with axis fractures between 2007 and 2013. Typical hangman's fractures were defined as traumatic spondylolisthesis of the axis causing a bilateral pars interarticularis fracture...
May 2016: Global Spine Journal
Akihiro Nitta, Toshinori Sakai, Yuichiro Goda, Yoichiro Takata, Kosaku Higashino, Tadanori Sakamaki, Koichi Sairyo
Lumbar spondylolysis, a stress fracture of the pars interarticularis, is prevalent in adolescent athletes. Recent advances in diagnostic tools and techniques enable early diagnosis before these fractures progress to complete fractures through the pars. However, because patients often consult family physicians for primary care of low back pain and these physicians may not have access to diagnostic modalities such as magnetic resonance imaging (MRI) and computed tomography, stress fractures can be missed. This study surveyed the prevalence of symptomatic spondylolysis in pediatric patients who consulted an orthopedic clinic for primary care and investigated whether such acute stress fractures may be overlooked without MRI...
May 1, 2016: Orthopedics
Subash C Jha, Toshinori Sakai, Mika Hangai, Akiko Toyota, Shoji Fukuta, Akihiro Nagamachi, Koichi Sairyo
Spondylolysis, a defect or stress fracture of the vertebral pars interarticularis, occurs most frequently in the lower lumbar spine and occasionally in the cervical spine, but is extremely rare in the thoracic spine. We report the case of a 17 year-old girl, an elite rhythmic gymnast, who reported with early-stage thoracic spondylolysis at T10 and T11 levels. Physicians should be aware that performance of unusual athletic movements, such as those by gymnasts, may lead to spondylolysis in rare locations.
2016: Journal of Medical Investigation: JMI
Jianqiang Mo, Wen Zhang, Dongyan Zhong, Hao Xu, Lan Wang, Jia Yu, Zongping Luo
OBJECTIVE: For multi-level spondylolysis patients, surgeons commonly choose to fix all the segments with pars interarticularis defect even those without slippage and not responsible for clinical symptoms. In this study, we tried to study the necessity of the preventative long-segment surgery for the defected segment without slippage in treatment of multi-level spondylolysis patients from a biomechanical perspective. METHOD: We established a bi-level spondylolysis model with pars defects at L4 and L5 segments, and simulated posterior lumbar interbody fusion (PLIF) and pedicle screw fixation at L5-S1 level...
2016: PloS One
Mitchell Hardenbrook, Sergio Lombardo, Miles C Wilson, Albert E Telfeian
OBJECTIVE The authors describe a cadaveric analysis to determine the ideal dimensions and trajectory for considering endoscopic transforaminal interbody implantation. METHODS The soft tissues of 8 human cadavers were removed from L-1 to the sacrum, exposing the posterior bony elements. Facetectomies were performed bilaterally at each lumbar level with resection of the pars interarticularis, revealing the pedicles, nerve roots, and interbody disc space. Each level was digitally photographed with a marker for scale and evaluated with digital analysis software...
February 2016: Neurosurgical Focus
Chun-Ming Zhao, Wen-Jie Zhang, Ai-Bing Huang, Qian Chen, Yuan-Long He, Wei Zhang, Hui-Lin Yang
Orthopaedic involvement is the most common clinical presentation of Neurofibromatosis type 1 (NF-1) patients with the spinal abnormalities more frequently affected. In the spinal deformities of NF-1 patients, despite the scoliosis is the most frequent finding, several distinctive radiographic features, such as dural ectasia, defective pedicles, and spondylolisthesis, are relatively less common. Here, we reported a 16-year-old boy diagnosed with NF-1 who presented with dural ectasia, defective pedicles, and spondylolisthesis concomitantly, described the surgical treatment and provided a literature review...
2015: International Journal of Clinical and Experimental Medicine
Kota Kojima, Shunji Asamoto
Background Fractures of the superior articular process are rarely seen in clinical practice. Repetitive spinal movements may lead to fractures of the pars interarticularis, resulting in spondylolysis. Traumatic spinal fractures often involve the vertebral body, transvers and/or the spinous processes. The superior articular processes, however, are seldom involved in both traumatic and stress-induced fractures. Purpose The purpose of this report is to present an unusual case of symptomatic bilateral fracture of the superior articular process of the sacrum in a 21-year-old speed skater...
January 13, 2016: British Journal of Neurosurgery
Xiaolong Zhu, Jian Wang, Yue Zhou, Zhengfeng Zhang, Changqing Li, Wenjie Zheng
OBJECTIVE: To analyze the effectiveness of direct screw repair for lumbar spondylolysis by using intraoperative O-arm based navigation and microendoscopic techniques. METHODS: Between February 2012 and May 2014, 11 consecutive patients with lumbar spondylolysis were treated with Buck's procedure by the aid of intraoperative O-arm based navigation and minimally invasive approach. The debridement and autograft of pars interarticularis defects was performed under microendoscopy...
October 2015: Chinese Journal of Reparative and Reconstructive Surgery
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