Spondylolysis: a review and treatment approach.

Low back pain, specifically "spondylo" conditions, has traditionally been misunderstood and often times ill-treated. A thorough understanding of the function of pars interarticularis and its relationship to the entire vertebral unit and low back health are essential for successful treatment and rehabilitation outcomes. Lifestyle awareness and controlled progression through the inflammation, stabilization, strength, and functional rehabilitation phases provide primary guidance for patients. In addition, a broad spectrum of pharmacological, psychological, therapeutic modality, and newer surgical techniques must be considered in the overall treatment plan. Having a strong understanding of the anatomy, biomechanics, treatment, and rehabilitation of this condition, will help the allied healthcare provider better meet the individualized needs of spondylolysis patients.

"Perfect health" versus "disease free": the impact of anchor point choice on the measurement of preferences and the calculation of disease-specific disutilities.

BACKGROUND: During preference testing, some investigators use "perfect health" as the upper anchor point of their measurement scale ("Q scale"), whereas others use "disease free" ("q scale"), which can confound the interpretation and comparison of study results. METHODS: We measured current health preferences among 74 patients with cervical spondylotic myelopathy (CSM) on both the Q and q scales using the visual analogue scale (VAS), standard gamble (SG), time tradeoff (TTO), and willingness to pay (WTP). RESULTS: There were significant differences in mean Q and q scale values for the VAS, SG, and WTP (for all, P < 0.011); there were no significant differences for mean TTO values (P = 0.592). CSM accounted for 63% to 82% of total disutility, whereas other comorbidities accounted for 28% to 37%. CONCLUSIONS: Preferences for CSM differ when measured on the Q and q scales. Caution should be used when comparing and interpreting health values measured on scales with different upper anchors.

Reasons for failure of L5-S1 intervertebral disc excisions.

This study reviews 247 patients who still had preoperative complaints six months to two years after disc excision. In over half, spondylosis of the L5-S1 facets was present, concurrently associated with a pelvic obliquity. A number of other organic causative factors were identified in 18% of the patients. Nonorganic reasons accounted for failure in only 13%. Over 70% of patients with associated spondylosis were improved by treatment directed at this condition.

[Clinical study of spondylolysis and spondylolisthesis--mainly on the spinal curvature].

The study was performed to aid in the selection of therapeutic methods for spondylolysis and spondylolisthesis. The subjects consisted of 359 cases, whose symptoms were analyzed using various X-ray examinations concerning the spinal curvature, as well as psychological tests. Age at onset of symptoms was most often in the 15-24-year range (34.7%). The symptom rate was 64.9% for spondylolysis and 75.0% for spondylolisthesis, increasing with age. The symptoms were almost all seen in the lumbar region. Abnormal mobility of the pars interarticularis was observed in 66.6% of the symptomatic group. The spinal curvature showed intensified kyphosis from the teens in the symptomatic group. Downward movement of the apex of the kyphosis and instability of the lumbar vertebral column, including abnormal mobility of the pars interarticularis, are assumed to play a major role in the appearance of symptoms. The above results seem to be helpful in deciding indications for operative therapy in cases with these diseases. From the above results, it appears that cases showing downward movement of the apex of the kyphosis and instability of the lumbar vertebral column are indicated for surgical treatment in consideration of the clinical findings, age, occupation, etc.