BACKGROUND CONTEXT: Although it has been well documented that slippage in patients with spondylolysis is most prevalent during the growth period, the exact time when slippage initiates and halts during the growth period is still unknown. Moreover, the contribution of spinal deformities, such as wedging of the vertebral body to the slippage, remains controversial. PURPOSE: To clarify when slippage in pediatric spondylolysis initiates and halts. STUDY DESIGN: Retrospective study. PATIENT SAMPLE: We radiographically examined 46 athletes under 18 years of age with spondylolysis at the fifth lumbar vertebra (L5). The mean age at the first consultation was 13.3 years. The average follow-up period was 6.0 years. OUTCOME MEASURES: Longitudinal observation of slippage at L5 on radiogram in correlation with the maturity of the lumbar spine. METHODS: From a lateral radiogram of each patient, percent slippage, lumbar index (LI), and skeletal age of the affected vertebra were measured. Changes in the percent slippage over time were investigated, and the correlation between the percent slippage and LI was analyzed. RESULTS: From the cartilaginous stage to the apophyseal stage, the slippage increased in 80.0% of the patients (16 of 20). From the cartilaginous stage to the epiphyseal stage, slippage increased in 11.1% of the patients (3 of 27). None of the patients (0 of 22) showed an increase after the epiphyseal stage. In 20 patients in whom slippage increased during the follow-up period, the percent slippage at the final consultation and the LI at the first consultation showed no significant correlation; however, the percent slippage and the LI at the final consultation were significantly (p<.01) correlated. CONCLUSION: In conclusion, slippage was more prevalent in individuals of a younger skeletal age whose lumbar spine was immature, and it halted during the epiphyseal stage when the growth period was over and the vertebra matured. Furthermore, the results suggest that wedge deformity of an affected vertebra might be the result rather than the cause of slippage.

Adolescent↗

PubMedDate not supplied

Pathogenesis of sports-related spondylolisthesis in adolescents. Radiographic and magnetic resonance imaging study.

We reviewed radiographs and magnetic resonance images of 77 young athletes with spondylolysis and spondylolisthesis (more than 5% vertebral slip) (slip group). The results were compared with similar studies in 88 patients with spondylolysis only (nonslip group). Endplate lesions were found in all patients in the slip group and in 60 (68%) of those in the nonslip group. Slippage between the osseous and cartilaginous endplates was identified in the T1-weighted sagittal magnetic resonance images and categorized according to the type of slippage: total slip of L-5 or S-1, partial slip of L-5 or S-1, or a combination of these (mixed type). In a study of 31 patients whose slippages progressed, no slippage was associated with the early stage of a pars interarticularis defect. Most vertebral slippages developed or progressed in the cartilaginous or apophyseal stage of the lumbar skeletal age. Wedging of the L-5 vertebral body and rounding of the sacrum progressed as the slippage developed; these did not occur in the nonslip group. These results indicate that the advanced stage of a pars interarticularis defect in an immature spine is a risk factor for spondylolisthesis. The deformities of the lumbosacral spine are thought to be the secondary changes caused by vertebral slippage.

Adolescent↗

PubMedDate not supplied

Characteristics of the protease activity in synovial fluid from patients with rheumatoid arthritis and osteoarthritis.

OBJECTIVE: To clarify which proteases are specifically activated in the lesions of rheumatoid arthritis (RA) and osteoarthritis (OA). METHODS: The activity levels of the serine proteases of the coagulation and fibrinolytic systems, and of elastase and collagenase as controls, in synovial fluid from 27 RA patients and 28 OA patients were measured using fluorogenic synthetic substrates which had methylcoumarylamide (MCA) at their COOH-termini. The thrombin-antithrombin III complex (TAT) content was also measured by ELISA. RESULTS: Among the proteases, thrombin-like activity was the highest in both RA and OA. The profiles of protease activity were similar in RA and OA, but their activities were in general significantly higher in RA than in OA (p < 0.01). The levels of both thrombin-like activity and TAT were about 7.5-fold higher in RA than in OA, while the levels of CRP and fibrinogen were only about 2-fold higher. Biochemical characterization of the thrombin-like activity in the synovial fluid of RA patients showed that this activity was due to thrombin. Thrombin-like activity positively correlated with the TAT concentration in RA (r = 0.750, p < 0.0001), but not in OA. CONCLUSION: Activation of the coagulation system was more marked in RA than in OA, strongly suggesting that in RA there is an imbalance between thrombin and its inhibitors, and that thrombin is more closely linked to the pathogenesis of RA than to that of OA. Our results also show that analysis of the synovial fluid may be useful to estimate the activation of the coagulation system in RA, but not that of the fibrinolytic system.

Adult↗