Article

Spondylolysis with and without anterolisthesis is the most common
cause of structural back pain in children and adolescents, but few predictive
factors have been confirmed.
An association between abnormal sacropelvic
orientation and both spondylolysis and spondylolisthesis has been supported in
the literature. Sacral slope and other sacropelvic measurements are easily
accessible variables that could aid clinicians in assessing active adolescents
with low back pain, particularly when the diagnosis of spondylolysis is
suspected. OBJECTIVE: To examine the relationship between sacral slope and
symptomatic spondylolysis in a cohort of active adolescents. DESIGN: Case-control
retrospective study. SETTING: Academic outpatient physiatry practice. PATIENTS:
Seventy-four patients of primarily adolescent age (between 12 and 22 years old)
with a chief complaint of low back pain and presence of lateral radiographs of
the lumbar spine were enrolled. Cases (n = 37) were defined as subjects with
evidence of spondylolysis on both radiograph and magnetic resonance imaging of
the lumbar spine. Controls (n = 37) were defined as subjects without
spondylolysis. METHODS: Using a single sagittal radiograph, taken with the
patient standing, a fellowship-trained interventional spine physiatrist measured
the sacral slope of each subject (angle between the superior plate of S1 and a
horizontal reference on sagittal imaging of the lumbosacral spine). Ages and
genders were collected from medical records. MAIN OUTCOME MEASUREMENTS: The
primary outcome was mean sacral slope. Mean sacral slope of cases was compared
with mean sacral slope of controls with the Student t-test. RESULTS: Ages ranged
from 12 to 22 for both groups, with no significant differences in age between the
groups (cases: 16.8 +/- 2.3 years; controls: 17.7 +/- 2.7 years). The patients
with spondylolysis (cases) consisted of 29 male and 8 female patients, whereas
those without spondylolysis (controls) consisted of 15 male and 21 female
patients (gender details for 1 patient were not available). The mean sacral slope
among cases was 42.4 degrees , whereas the mean sacral slope among controls was
37.4 degrees . The difference achieved significance (P = .014). CONCLUSIONS: The
interdependence of positional parameters, such as sacral slope, with anatomic
parameters, such as pelvic incidence, can affect lumbar lordosis and therefore
upright positioning and loading of the spine. Sacral slope may be an important
variable for clinicians to consider when caring for young athletes with low back
pain, particularly when the index of suspicion for spondylolysis is high. LEVEL
OF EVIDENCE: IV.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS