Causes of Radiculopathy in Young Athletes With Spondylolysis

The American Journal of Sports Medicine 38:357-362 (2010)
Koichi Sairyo, MD, PhD, Toshinori Sakai, MD, PhD, Rui Amari, MD and Natsuo Yasui, MD, PhD 
From the Department of Orthopedics, The University of Tokushima, Tokushima, Japan
Address correspondence to Koichi Sairyo, MD, PhD, Department of Orthopedics, The University of Tokushima School of Medicine, 3-18-15, Kuramoto, Tokushima 770-8503, Japan (e-mail: sairyokun@hotmail.com).

Background: The main clinical symptom of lumbar spondylolysis is lower back pain. Radiculopathy rarely occurs without vertebral slippage.

Hypothesis: Spondylolysis in young athletes can cause lumbar radiculopathy.

Study Design: Case series; Level of evidence, 4.

Methods: Ten patients (7 males and 3 females) were included in this study. The age of the patients ranged from 12 to 27 years. We employed plain radiography, computed tomography, magnetic resonance imaging, and selective radiculography if needed.

Results: The pathomechanism was classified into nonspondylolytic radiculopathy (3 cases) and spondylolytic radiculopathy (7 cases). In the nonspondylolytic group, 1 patient had a juxta-facet cyst at L4-5 and 2 patients had a herniated nucleus pulposus. In the other group, spondylolytic-related factors caused radiculopathy, and spondylolysis was in the early or progressive stage in all 7 patients. Radiologic findings indicated that radiculopathy was caused by extraosseous hematoma or edema in the vicinity of the fracture site. The radiculopathy disappeared within a month of nonoperative management, and radiologic abnormalities disappeared 3 to 6 months later.

Conclusion: Radiculopathy can occur together with lumbar spondylolysis without slippage in young athletes. We propose extra-osseous hematoma or edema at the site of spondylolysis as the unique pathomechanism causing radiculopathy in young athletes. Radiculopathy is rare in athletes with spondylolysis. Magnetic resonance imaging is a useful tool to clarify the pathologic changes that induce the radiculopathy for both spondylolytic and nonspondylolytic factors.

Impact of headache on young people in a school population.

Br J Gen Pract. 2009 Aug 11. [Epub ahead of print] Links

Impact of headache on young people in a school population.

Kernick D, Reinhold D, Campbell JL.

Background Headache is the most frequent neurological symptom and the most common manifestation of pain in childhood. Estimates of the prevalence of headache in children and adolescents vary widely (depending on the setting, methodology, and diagnostic criteria applied) and the impact is not well understood.AimTo quantify the impact of headache in a school population.Design of studyA questionnaire survey.SettingExeter schools.MethodA total of 1037 school children between the ages of 12 and 15 years were surveyed, of whom 49% were female. Main outcome measures were headache frequency, disease-specific impact using the Pediatric Migraine Disability Assessment Score (PedMIDAS), and generic quality of life impact using the Pediatric Quality of Life Inventory (PedsQL4).Results Twenty per cent of the study population had headache one or more times a week, with an average PedMIDAS score of over 12.1 (and an impact on over 12 days in a 3-month period). Ten per cent of the population had a PedMIDAS score of 16.8 and a PedsQL4 generic quality of life score of 70.1, indicating a poorer quality of life than that of children with asthma, diabetes, or cancer. An average of 0.6 days of school was lost in a 3-month period across all school children.Conclusion There is a significant impact of headache on the quality of life of children. This impact is both unrecognised and unmet. GPs have an important role in identification and management of this problem.

PMID: 19674513 [PubMed - as supplied by publisher]

PMCID: PMC2734356 [Available on 2010/09/01