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      • KCI등재

        Bone Healing in Adolescents with Bilateral L5 Spondylolysis with and without Preexisting Contralateral Terminal Spondylolysis

        Eto Fumihiko,Tatsumura Masaki,Gamada Hisanori,Okuwaki Shun,Koda Masao,Yamazaki Masashi 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.6

        Study Design: Retrospective cohort study. Purpose: To examine bone healing with conservative treatment in cases of adolescent bilateral L5 spondylolysis. Overview of Literature: We classified bilateral L5 spondylolysis, which is the most affected spinal level, by fracture stage and aimed to compare the bone healing rate according to the fracture stage and evaluate the presence of a preexisting contralateral terminal fracture at the diagnosis of fresh spondylolysis. Methods: We evaluated 48 patients (38 boys and 10 girls) with bilateral L5 spondylolysis diagnosed during or before high school. L5 spondylolysis was classified into two groups: fresh group (bilateral fresh spondylolysis cases), and terminal group (cases wherein one side had fresh spondylolysis and the contralateral side had terminal spondylolysis). We investigated the age of examination and bone healing rate in both groups. We investigated progressive-stage lesions and bone healing rate with or without progressive-stage lesions. Results: The bone healing rate in the fresh group was significantly higher than that in the terminal group 72.0% vs. 26.1%, p=0.003). In both the groups, the bone healing rate was significantly higher in patients without progressive-stage lesions than in those with progressive-stage lesions. Conclusions: Bone healing of progressive-stage fresh spondylolysis was not achieved by conservative treatment when contralateral terminal spondylolysis was present in adolescents with bilateral L5 spondylolysis. Our results suggest that bilateral L5 spondylolysis treatment strategies must be determined based on the combination of the stages present.

      • KCI등재

        Conservative Treatment and Unfavorable Factors to Bone Healing of “Pre-lysis”-Stage Lumbar Spondylolysis in Adolescents

        Gamada Hisanori,Tatsumura Masaki,Okuwaki Shun,Yamazaki Masashi 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.2

        Study Design: Retrospective cohort study.Purpose: To evaluate the clinical outcomes of the conservative treatment of “pre-lysis”-stage lumbar spondylolysis.Overview of Literature: With the widespread use of magnetic resonance imaging (MRI) for early diagnosis of lumbar spondylolysis, a new disease stage called pre-lysis has emerged, in which intensity change is observed only on MRI without a fracture line on computed tomography. This study aimed to evaluate the clinical outcomes and factors unfavorable to bone healing of the conservative treatment of pre-lysis-stage lumbar spondylolysis.Methods: Fifty-three patients with 57 fresh pre-lysis-stage lesions who had completed conservative treatment were included in the study (40 men, 13 women; mean age, 14.3 years). We investigated the rate of bone healing and the relationship between bone healing after conservative therapy and factors such as age, sex, vertebral level, unilateral/bilateral lesions, and presence of spina bifida occulta.Results: The overall bone healing rate was 95% (54/57 lesions). Bilateral lesions had a significantly lower bone healing rate than unilateral lesions (86% vs. 100%, p=0.046). There were no statistically significant differences based on age, sex, vertebral level, or presence of spina bifida occulta.Conclusions: The bone healing rate in unilateral lesions was 100%, which was significantly higher than that in bilateral lesions. It is important to detect and initiate treatment while the lesion is still unilateral, if possible.

      • KCI등재

        Tumor Occupation in the Spinal Canal and Clinical Symptoms of Cauda Equina Schwannoma: An Analysis of 22 Cases

        Kengo Fujii,Masataka Sakane,Tetsuya Abe,Tsukasa Nakagawa,Shinsuke Sakai,Masaki Tatsumura,Toru Funayama,Masashi Yamazaki 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.6

        Study Design: Retrospective, radiological study. Purpose: To determine the relationship between clinical symptoms and the extent of tumor occupation of the spinal canal by cauda equina schwannoma. Overview of Literature: Little is known about the relationship between the size of tumors of the cauda equina and the manifestation of clinical symptoms. We analyzed this relationship by estimating the percentage of tumor occupation (PTO) in the spinal canal in cauda equina schwannomas and by correlating this parameter with the presence and severity of clinical symptoms. Methods: Twenty-two patients (9 men and 13 women; age, 19–79 years; mean age, 55.3 years) who were radiologically diagnosed with schwannomas of the cauda equina between April 2004 and July 2014 were retrospectively analyzed. PTO was measured in axial and sagittal magnetic resonance imaging slices in which the cross-sectional area of the tumor was the largest. Data regarding clinical symptoms and results of physical examinations were collected from patient medical records. PTO differences between symptompositive and -negative groups were analyzed for each variable. Results: In the 4 cases in which tumor presence was not related to clinical symptoms, PTO was 5%–10% (mean, 9%) in axial slices and 23%–31% (mean, 30%) in sagittal slices. In the 18 cases in which symptoms were associated with the tumor, PTO was 11%–86% (mean, 50%) in axial slices and 43%–88% (mean, 71%) in sagittal slices. PTO in axial slices was significantly higher in the presence of Déjèrine symptoms and/or muscle weakness, a positive straight leg raise test, and a positive Kemp sign. Conclusions: PTO >20% in axial slices and >40% in sagittal slices can be an indication of symptomatic cauda equina schwannoma.

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