Purpose: This study aimed to investigate the treatment effects of low-intensity pulsed ultrasound (LIPUS) on progressive-stage spondylolysis. Spondylolysis is a stress fracture of the pars interarticularis. Based on the results of computed tomography, spondylolysis was classified into three categories: early, progressive, and terminal. Bone healing was prolonged or not obtained in progressive-stage spondylolysis. The progression of spondylolysis to nonunion has been associated with an increased incidence of spondylolisthesis. To prevent these clinical conditions, achieving bony healing of the spondylolysis site should be the goal of treatment.
Methods: 15 consecutive pediatric patients with progressive-stage spondylolysis (defects) with MRI high-signal change were analyzed. Nine patients were treated conservative treatment including avoidance of any sport activity and the use of a brace during treatment (conventional). Six patients were treated using LIPUS everyday during treatment in addition to conservative treatment. Approximately every 1.5 months, bone healing was evaluated via CT. Cases that retained defects after 4.5 months were defined as nonunion.
Results: Two patients dropped out during the study period. A total of 13 patients (mean 14.6 ± 2.5 years) from the database met with 19 interarticularis defects. The bone union rate in LIPUS group was significantly higher than that in conventional group (66.7 vs. 10.0%, p = 0.020). The treatment period to bone union was 3.8 months and 2.7 ± 0.3 months in conventional and LIPUS groups.
Conclusions: This study revealed that LIPUS treatment might be effective for bone union in patients with progressive-stage spondylolysis with MRI high-signal change.
Level of evidence: 4.
Keywords: Bone union; Conservative treatment; Interarticularis defects; Low-intensity pulsed ultrasound (LIPUS); Pediatric lumbar spondylolysis.