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JBJS Case Connect 2021 04 7;11(2). Epub 2021 Apr 7.

Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.

Case: Multilevel lumbar spondylolistheses have been reported, but only secondary to degenerative processes. We describe a case where grade 4 anterolisthesis occurred (L3,4,5 over S1) because of multiple level traumatic pedicle avulsion rather than facetal/pars interarticularis/posterior ligamentous complex disruption in a 42-year-old man who presented with paraparesis after a fall from height. Decompression was performed at the L5 level, and pedicle screw fixation was performed at L3, L5, and S1 levels. Read More

Eur Spine J 2021 Mar 18. Epub 2021 Mar 18.

Dept. Spine Surgery, London Bridge Hospital, St Olaf House, 27 Tooley street, London, SE1 2PR, UK.

Purpose: Odontoid process fractures can extend rostral into the C2 arch. We investigated the clinical impact of a concurrent fracture of the pars interarticularis on odontoid failure. To overcome the surgical challenges related to the morphology of these fractures, we describe a novel surgical strategy using atlantoaxial joint distraction arthrodesis. Read More

Arch Orthop Trauma Surg 2021 Mar 7. Epub 2021 Mar 7.

Department of Spine Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Germany.

Purpose: In this work, a modification of the percutaneous surgical approach for removing the lumbar foraminal disc prolapse is introduced.

Material And Methods: A prospective study was performed. The indication for surgery was foraminal disc prolapse presenting with acute motor or persistent sensory radiculopathy. Read More

Sports Med Open 2020 Nov 25;6(1):57. Epub 2020 Nov 25.

Game Insight Group, Tennis Australia, Melbourne, Australia.

Background: Lumbar spine abnormalities, in particular stress fractures to the pars interarticularis, are common in elite junior tennis players, though the difference in prevalence between males and females remains unclear. Further, facet joint orientation appears to be a possible option for recognizing which players might go on to present with a pars stress fracture. Given the link between pars stress fractures and low back pain in tennis players, it appears logical to explore the link between facet joint angle and pars abnormalities. Read More

J Neurosci Rural Pract 2020 Oct 29;11(4):663-666. Epub 2020 Oct 29.

Department of Neurosurgery SMS Medical College, Jaipur, Rajasthan, India.

Traumatic spondylolisthesis of axis or hangman's fracture is the second most common C2 vertebra injury. We present a report of a young man presenting with a history of fall from height with C2 to C3 spondylolisthesis without any evidence of injury to pars interarticularis but with associated injury to capsular ligament of facet joint along with posterior spinous ligamentous injury. The patient underwent intraoperative reduction in listhesis with posterior screw fixation. Read More

Bone 2021 02 3;143:115626. Epub 2020 Sep 3.

Cricket Australia, 60 Jolimont St, Jolimont, Victoria 3002, Australia; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne 3086, Australia.

Objectives: 1) Quantify the intensity of bone marrow oedema (BMO) present in the lumbar vertebrae of asymptomatic elite adult fast bowlers; 2) relate the intensity of BMO to bowling workload and lumbar bone stress injury (LBSI), and; 3) evaluate the utility of MRI screening to reduce the risk of LBSI.

Methods: Thirty-eight elite Australian fast bowlers (21.6 ± 3. Read More

World Neurosurg 2020 11 11;143:339-345. Epub 2020 Aug 11.

Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India.

Background: The term "pediculolysis" encompasses rare, chronic pedicular changes characterized by pedicle hypertrophy, sclerosis, and pseudoarthrosis, which develop secondary to recurrent microfractures from repeated stress injuries. These stress injuries to pedicles can be insufficiency fractures, commonly reported in elderly patients with associated osteoporosis, or fatigue fractures, which occur in young adolescents involved in heavy sports. These pedicular lesions have been reported in association with defects in other components of the neural arch, including the pars interarticularis and lamina. Read More

J Sci Med Sport 2021 Feb 9;24(2):112-115. Epub 2020 Jul 9.

Lifecare Prahran Sports Medicine, Australia.

Objectives: Review magnetic resonance imaging (MRI) of elite adult fast bowlers with a history of lumbar spine stress fracture for evidence of bone healing. The findings will determine whether bone healing can occur in this population, and whether MRI may be used as a tool to assess bone healing and inform clinical decision making.

Design: Retrospective cohort. Read More

Clin Imaging 2020 Oct 1;66:1-6. Epub 2020 Apr 1.

Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908, USA. Electronic address:

We report a case of symptomatic Oppenheimer ossicle in an 18-year-old male who presented with back pain. L5 pars interarticularis defect was suspected on initial lumbar spine radiographs. A subsequent technetium99m-methylene diphosphonate (Tc99m-MDP) bone scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed focal radiotracer uptake in an Oppenheimer ossicle in L2 vertebra. Read More

JBJS Essent Surg Tech 2020 Jan-Mar;10(1). Epub 2020 Mar 23.

Johns Hopkins University, Baltimore, Maryland.

Spondylolysis, defined as injury to the pars interarticularis, is the most common identifiable cause of back pain in children. Historically, treatment has primarily been nonoperative, including physical therapy, activity modification, and occasionally bracing. In instances in which the condition is refractory to nonoperative management, however, surgical treatment may be an efficacious alternative. Read More

BMC Neurol 2020 Apr 29;20(1):162. Epub 2020 Apr 29.

Department of Anesthesia, Stanford University, Palo Alto, CA, USA.

Background: Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak.

Methods: This is a retrospective case series of 6 patients with suspected spinal CSF leak evaluated between January 2016 and September 2019. Read More

World Neurosurg 2020 07 26;139:370-372. Epub 2020 Apr 26.

Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, India; Department of Neurosurgery, Lilavati Hospital and Research Centre, Bandra East, Mumbai, India. Electronic address:

Background: We report a rare case of Hangman's fracture in a male child with osteopetrosis.

Case Description: A 7-year-old boy was earlier diagnosed to have 'osteopetrosis'. He presented with neck pain, restriction of neck movements and quadriparesis following a fall while playing at home. Read More

Int J Sports Phys Ther 2020 Apr;15(2):287-300

Division of Sports Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States.

Low back pain in adolescent athletes is quite common, and an isthmic spondylolysis is the most common identifiable cause. Spondylolysis, a bone stress injury of the pars interarticularis, typically presents as focal low back pain which worsens with activity, particularly with back extension movements. Research on spondylolysis has focused on diagnosis, radiographic healing, the effects of bracing, and rest from activity. Read More

World Neurosurg 2020 06 23;138:449-453. Epub 2020 Mar 23.

Department of Neurological Surgery, Loyola University Chicago, Maywood, Illinois, USA. Electronic address:

Background: Surgical intervention for type II odontoid fractures is a common treatment strategy when conservative management is not appropriate, such as in significantly displaced fractures. However, displaced fractures may not be easily reduced with instrumentation alone. We present a novel technique, using a "bucket-handle" construct to manually reduce a dorsally displaced type II odontoid fracture, in a patient with failure of previously placed dorsal instrumentation. Read More

Neurospine 2020 Sep 2;17(3):659-665. Epub 2020 Feb 2.

Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Objective: Conventional techniques for atlantoaxial fixation and fusion typically pass cables or wires underneath C1 lamina to secure the bone graft between the posterior elements of C1-2, which leads to complications such as cerebrospinal fluid (CSF) leak and neurological injury. With the evolution of fixation hardware, we propose a novel C1-2 fixation technique that avoids the morbidity and complications associated with sublaminar cables and wires.

Methods: This technique entails wedging and anchoring a structural iliac crest graft between C1 and C2 for interlaminar arthrodesis and securing it using a 0-Prolene suture at the time of C1 lateral mass and C2 pars interarticularis screw fixation. Read More

Spine Surg Relat Res 2019 Apr 25;3(2):146-150. Epub 2018 Aug 25.

Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.

Introduction: In past biomechanical studies, repetitive motion of lumbar extension, rotation, or a combination of both, frequently seen in batting or pitching practice in baseball, shooting practice in soccer, and spiking practice in volleyball, have been considered important risk factors of lumbar spondylolysis. However, clinically, these have been identified in many athletes performing on a running track or on the field, which requires none of the practices described above. The purpose of this study was to verify how much impact running has on the pathologic mechanism of lumbar spondylolysis. Read More

J Neurosurg Sci 2019 Jun;63(3):318-329

Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA -

Introduction: The repair of symptomatic isthmic pars interarticularis fractures can result in excellent outcomes. A variety of operative interventions exist with conventional techniques requiring larger exposures. Recently described, less invasive techniques tend to minimize disruption of adjacent soft tissues, decrease postoperative pain, increase patient satisfaction, and improve return to work status and/or competitive sports. Read More

Oper Neurosurg (Hagerstown) 2020 Jan;18(1):E8

Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Republic of Korea.

The conventional surgical approach to far lateral lumbar disk herniations is a paraspinal Wiltse approach. During the Wiltse approach, it is sometimes necessary to resect some of the facet or pars interarticularis to achieve an adequate exposure. The endoscopic transforaminal route can be of benefit in far lateral disk herniations due to direct access to the epidural space through Kambin's triangle, without the need for any bony removal or nerve retraction. Read More

Curr Opin Pediatr 2019 02;31(1):61-68

Washington University in St. Louis, St. Louis, Missouri, USA.

Purpose Of Review: Provide a comprehensive overview of lumbar spondylolysis, a frequent cause of lower back pain in children and adolescents, from evaluation to management.

Recent Findings: With the surge of structured sports participation in the pediatric population, spondylolysis is a common ailment that afflicts many young athletes due to rigorous competition that taxes the growing spine with repetitive extension and rotation.

Summary: Spondylolysis is a fracture through the pars interarticularis. Read More

Eur J Radiol 2018 Nov 1;108:28-42. Epub 2018 Sep 1.

Fortius Clinic, 17 Fitzhardinghe Street, London W1H 6EQ, United Kingdom. Electronic address:

Injuries of the lumbar neural arch, in particular the pars interarticularis, are widely considered to be due to abnormal bone stress secondary to repetitive loading/shearing, and are a common pathology and a main cause of lower back pain in elite athletes across a range of sports. Medical imaging plays a pivotal role in the diagnosis, monitoring and prognostication of neural arch injury. Early detection is highly desirable in the young elite athlete, as early injuries have been shown to require shorter recovery time and have a higher potential of full healing, whilst accurate grading of injury allows appropriate rehabilitation planning. Read More

World Neurosurg 2019 Feb 1;122:e790-e794. Epub 2018 Nov 1.

Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA. Electronic address:

Objective: Lumbar spondylolisthesis can be related to facet arthropathy and disc degeneration or to a fracture of the pars interarticularis, but the mechanistic underpinnings of spondylolisthesis remain unclear. We posit that high sacral slope and body weight increase sacral inclination vector forces, which leads to pars fractures and exacerbates risk for spondylolisthesis.

Methods: To investigate this hypothesis, we measured the sacral slope, body weight, and S1 endplate vector forces for patients who underwent L5-S1 fusion for grade I spondylolisthesis. Read More

World Neurosurg 2018 Nov 24;119:389-393. Epub 2018 Aug 24.

Department of Neurosurgery Charité University Hospital, Berlin, Germany. Electronic address:

Background: Nonlethal cervical spine injuries in skydiving are rare due to the associated high mortality. Here, we report an unusual pathomechanism leading to a Hangman fracture in a semiprofessional parachute athlete.

Case Description: The moment of injury was captured on a first-person video and identified as a rough parachute opening deceleration during canopy deployment, caused by failure of the parachute inflation control device. Read More

World Neurosurg 2018 Nov 9;119:e848-e854. Epub 2018 Aug 9.

Department of Operating Room and Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.

Objective: The literature on surgical management of atypical hangman's fracture (AHF) is sparse. The aim of this study was to describe an individual surgical strategy using a lag screw-rod technique for treatment of unstable AHF based on different fracture patterns.

Methods: A retrospective analysis of 23 patients with unstable AHF was performed. Read More

J Neuroimaging 2018 11 10;28(6):635-639. Epub 2018 Jul 10.

Department of Radiology and Nuclear Medicine, University of Washington Medical Center, Seattle, WA.

Background And Purpose: To assess benefits of hybrid (single photon emission computerized tomography [SPECT]/computed tomography [CT]) imaging over SPECT imaging only in the management of young athletes with low back pain (LBP) due to suspected pars interarticularis fracture.

Methods: Retrospectively reviewed medical records of 163 consecutive patients who had radionuclide SPECT imaging for evaluation of LBP between January 1, 2010 and December 30, 2015. All enrolled patients were divided into two groups (group 1: patients with radionuclide SPECT imaging only and group 2: patients with radionuclide hybrid imaging). Read More

Acta Neurochir (Wien) 2018 08 23;160(8):1621-1623. Epub 2018 Jun 23.

Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.

Congenital craniovertebral junction deformities can be associated with an anomalous vertebral artery (VA). At times, the artery crosses the joint posteriorly (i.e. Read More

Neurochirurgie 2018 Sep 3;64(4):327-330. Epub 2018 May 3.

CHU de Strasbourg, hôpital de Hautepierre, service de neurochirurgie, 67200 Strasbourg, France.

Introduction: Grisel's syndrome consists in rotational subluxation of C1-C2 following ENT infection or surgery. There is no consensus on management. We present 2 cases requiring surgical treatment in our center. Read More

J Med Case Rep 2018 Apr 27;12(1):110. Epub 2018 Apr 27.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa City, Ishikawa, 920-8641, Japan.

Background: Although microendoscopy-assisted lumbar discectomy for lateral or extraforaminal lumbar disc herniations via the lateral approach has previously been reported, microendoscopy-assisted lumbar discectomy for central or paramedian disc herniations via the lateral approach has not been reported. We report the first case of recurrent upper lumbar disc herniation (L2-L3) treated with microendoscopy-assisted lumbar discectomy via the transforaminal approach. No microendoscopy-assisted lumbar discectomy for recurrent upper lumbar disc herniation via the transforaminal approach has previously been reported. Read More