Background:Pediatric lumbar spondylolysis, a stress fracture of the lumbar spine, frequently affects young athletes, and nonoperative treatment is often the first choice of management. Because the union rate in lumbar spondylolysis is lower than that in general fatigue fractures, identifying risk factors for nonunion is essential for optimizing treatment.Purpose:To determine the risk factors for nonunion after nonoperative treatment of acute pediatric lumbar spondylolysis through multivariate analysis.Study Design:Case-control study; Level of evidence, 3.Methods:We analyzed 574 pediatric patients (mean age, 14.3 ± 1.9 years) with lumbar spondylolysis who underwent nonoperative treatment between 2015 and 2022. Nonoperative treatment included the elimination of sports activities, bracing, and weekly athletic rehabilitation, with follow-up computed tomography. Patient data, lesion characteristics, sports history, presence of spina bifida occulta at the lamina with a lesion or at the lumbosacral spine excluding the lesion level, and lumbosacral parameters were examined. Differences between the union and nonunion groups were investigated using multivariate analysis to determine the risk factors for nonunion.Results:Of the 574 patients, 81.7% achieved bone union. Multivariate analysis revealed that an L5 lesion and the progression of the main and contralateral lesion stages were significant independent risk factors for nonunion. An L5 lesion had a lower union rate than non-L5 lesions. As the main lesion progressed, the likelihood of nonunion increased significantly, and the progression of the contralateral lesion also showed a similar trend. Spina bifida occulta and lumbosacral parameters were not significant predictors of nonunion in this study.Conclusion:We identified the L5 lesion level and the progression of the main and contralateral lesion stages as independent risk factors for nonunion in pediatric lumbar spondylolysis after nonoperative treatment. These findings aid in treatment decision-making. When bone union cannot be expected with nonoperative treatment, symptomatic treatment is required without prolonged external fixation and rest, and without aiming for bone union. Individualized treatment plans are crucial based on identified risk factors.

中文翻译：

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小儿腰椎峡部裂非手术治疗后骨不连的危险因素：回顾性病例对照研究


背景：小儿腰椎峡部裂是一种腰椎应力性骨折，经常影响年轻运动员，非手术治疗通常是首选治疗方法。由于腰椎峡部裂的愈合率低于一般疲劳性骨折，因此识别骨不连的危险因素对于优化治疗至关重要。目的：通过多因素分析确定小儿急性腰椎峡部裂非手术治疗后骨不连的危险因素。研究设计：病例对照研究；证据级别，3。方法：我们分析了 2015 年至 2022 年间接受非手术治疗的 574 名腰椎峡部裂儿童患者（平均年龄，14.3 ± 1.9 岁）。非手术治疗包括取消体育活动、支具和每周运动康复，进行后续计算机断层扫描。检查患者数据、病变特征、运动史、病变椎板或腰骶椎（不包括病变水平）是否存在隐性脊柱裂，以及腰骶参数。采用多变量分析研究愈合组和不愈合组之间的差异，以确定骨不连的危险因素。结果：574 例患者中，81.7% 达到骨愈合。多变量分析显示，L5 病变以及主要和对侧病变阶段的进展是骨不连的重要独立危险因素。 L5 病变的愈合率低于非 L5 病变。随着主病灶的进展，骨不连的可能性显着增加，对侧病灶的进展也呈现出类似的趋势。在本研究中，隐性脊柱裂和腰骶参数并不是骨不连的显着预测因素。结论：我们确定L5病变级别以及主侧和对侧病变阶段的进展是小儿腰椎峡部裂非手术治疗后骨不连的独立危险因素。这些发现有助于治疗决策。当非手术治疗无法达到骨愈合时，需要对症治疗，无需长时间外固定和休息，也不以骨愈合为目标。根据已确定的风险因素制定个体化治疗计划至关重要。