Clinical Features and Therapeutic Process of Sacral Fatigue Fractures in Adolescents.

BACKGROUND: Sacral fatigue fractures are a rare injury but should be considered as a differential diagnosis for low back and buttock pain in young adults. Collective reports are limited, most of which have focused on long-distance runners. PURPOSE: To investigate the characteristics of sacral fatigue fractures in adolescents. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We analyzed patient background characteristics, physical examination and imaging findings, and treatment courses of those diagnosed with sacral fatigue fractures using magnetic resonance imaging. RESULTS: Among 34 patients with sacral fatigue fractures, 15 and 19 were male and female patients, respectively, with an age range of 11 to 19 years (mean age, 15.0 years). Almost all patients were athletes, and 29 patients performed their sport ≥5 times a week. Long-distance runners were the most commonly affected, comprising 7 patients, and participants in other common sports such as baseball (6 patients), basketball (4 patients), and soccer (3 patients) were also affected. Physical examination revealed tension sign (Lasègue test) on the affected side in 6 patients and tight hamstrings in 24 patients. Imaging findings included 18 patients with right-side involvement, 12 with left-side involvement, and 4 with involvement on both sides. In 11 patients, spina bifida occulta was observed at S1 and 8 patients had a history of lumbar spondylolysis with 4 patients having concurrent sacral fatigue fractures. Physical therapy was performed concurrently with the cessation of exercise, and return to exercise was permitted if the pain had been relieved after 1 month. All patients returned to sports at a median of 48 days (range, 20-226 days) after symptom onset. However, 2 patients experienced recurrence (1 patient on the ipsilateral side and 1 patient on the contralateral side). CONCLUSION: Sacral stress fractures are not limited to long-distance runners in this population and can manifest as lower back pain or buttock pain in athletes participating in a variety of sports. Although the course of treatment was generally good, the possibility of recurrence must always be considered.

Rate and Duration of Bone Union for Conservative Treatment in Pediatric Lumbar Spondylolysis.

STUDY DESIGN: Retrospective case series. OBJECTIVE: To report the detailed bone fusion rates and duration of treatment in unilateral and bilateral cases of pediatric lumbar spondylolysis (LS). SUMMARY OF BACKGROUND DATA: Early diagnosis and optimal conservative management for LS are crucial for achieving bony healing without surgery. However, existing research on the conservative treatment of pediatric LS, particularly regarding bone union rates and treatment duration for each stage of bilateral spondylolysis, is limited. METHODS: We retrospectively analyzed 590 pediatric patients (522 boys and 68 girls) under 18 years of age diagnosed with LS and treated conservatively from 2015 to 2021. Diagnosis was based on computed tomography scans and magnetic resonance imaging findings, with stages classified as very early, early, progressive, or terminal. Patient background, sports history, level and stage of spondylolysis, presence of spina bifida occulta, bone union rate, duration of conservative treatment, and recurrence rate were retrospectively analyzed. RESULTS: The overall bone union rate was 81.9%, with a mean conservative treatment duration of 53.7 days. Unilateral LS cases showed decreased bone union rates with stage advancement (very early; 98.2%, early; 96.0%, progressive; 64.3%). Bilateral LS cases with progressive or terminal stage demonstrated low bone union rates (very early/very early; 100%, early/very early; 94.1%, progressive/very early; 66.7%, early/early; 82.9%, progressive/early; 32.3%, progressive/progressive; 23.7%, very early/terminal; 0%, early/terminal; 50.0%, progressive/terminal; 11.1%). The duration of conservative treatment extended as the stage of the main and contralateral lesions progressed, ranging from 39.1 days (very early/none) to 105 days (progressive/terminal). Recurrence rate after bone fusion was 16.6%, with no differences based on lesion stage. CONCLUSION: In this series of 590 patients, conservative treatment yielded high bone union rates for pediatric LS. However, union rates decreased with stage advancement, especially in bilateral cases. These findings provide valuable insights for prognosticating natural history and outcome regarding LS treatment, bone union and return to activity.

Preoperative Low Back Pain Affects Postoperative Patient Satisfaction Following Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery.

STUDY DESIGN: A single-center retrospective study. PURPOSE: To research the predictive factors associated with postoperative patient satisfaction 1 year after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), a minimally invasive procedure for lumbar degenerative disease. OVERVIEW OF LITERATURE: There have been reports of numerous variables influencing patient satisfaction with lumbar surgery; however, there have been few investigations on MIS are limited. METHODS: This study included 229 patients (107 men and 122 women; mean age, 68.9 years) who received one or two levels of MISTLIF, and the patient's age, gender, disease, paralysis, preoperative physical functions, duration of symptom(s), and surgery-associated factors (waiting for surgery, number of surgical levels, surgical time, and intraoperative blood loss) were studied. Radiographic characteristics and clinical outcomes such as Oswestry Disability Index (ODI) scores and Visual Analog Scale (VAS; 0-100) ODI scores for low back pain, leg pain, and numbness were studied. One year following surgery, patient satisfaction (defined as satisfaction for surgery and for present condition; 0-100) was assessed using VAS and its relationships with investigation factors were examined. RESULTS: The mean VAS scores of satisfaction for surgery and for present condition were 88.6 and 84.2, respectively. The results of multiple regression analysis showed that preoperative adverse factors of satisfaction for surgery were being elderly (ß =-0.17, p =0.023), high preoperative low back pain VAS scores (ß =-0.15, p =0.020), and postoperative adverse factors were high postoperative ODI scores (ß =-0.43, p <0.001). In addition, the preoperative adverse factor of satisfaction for present condition was high preoperative low back pain VAS scores (ß =-0.21, p =0.002), and postoperative adverse factors were high postoperative ODI scores (ß =-0.45, p <0.001) and high postoperative low back pain VAS scores (ß =-0.26, p =0.001). CONCLUSIONS: According to this study, significant preoperative low back pain and high postoperative ODI score after surgery are linked to patient unhappiness.

Influence of the Preoperative Duration of Symptoms on Patients' Clinical Outcomes after Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Spinal Diseases.

Background and Objectives: The impact of the duration of symptoms (DOS) on postoperative clinical outcomes of patients with degenerative lumbar spinal diseases is important for determining the optimal timing of surgical intervention; however, the timing remains controversial. This prospective case−control study aimed to investigate the influence of the preoperative DOS on surgical outcomes in minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF). Materials and Methods: Patients who underwent single-level TLIF for lumbar degenerative diseases between 2017 and 2018 were reviewed. Only patients with full clinical data during the 1-year follow-up period were included. The patients were divided into two groups (DOS < 12 months, group S; DOS ≥ 12 months, group L). The clinical outcomes, including the Oswestry disability index (ODI) and visual analog scale (VAS) for lower back pain, leg pain, and numbness, were investigated preoperatively and at 1, 3, and 6 months, as well as 1 year, after surgery. Furthermore, postoperative patient satisfaction 1 year after surgery was also surveyed. Results: A total of 163 patients were assessed: 60 in group S and 103 in group L. No differences in baseline characteristics and clinical outcomes were found. The ODI and VAS significantly improved from the baseline to each follow-up period (all p < 0.01). Group S had significantly lower ODI scores at 3 months (p = 0.019) and 6 months (p = 0.022). In addition, group S had significantly lower VAS scores for leg pain at 3 months (p = 0.027). In a comparison between both groups, only the patients with cauda equina symptoms showed that ODI and leg pain VAS scores at 3 months after surgery were significantly lower in group S (19.9 ± 9.1 vs. 14.1 ± 12.5; p = 0.037, 7.4 ± 13.9 vs. 14.7 ± 23.1; p = 0.032, respectively). However, the clinical outcomes were not significantly different between both groups 1 year after surgery. Patient satisfaction was also not significantly different between both groups. Conclusions: Patients with a shorter DOS tended to have a significantly slower recovery; however, clinical outcomes 1 year after surgery were good, regardless of the DOS.