Factors Associated with the Symptoms of Young Adults with L5 Spondylolysis

STUDY DESIGN: A retrospective cohort study. PURPOSE: To investigate the factors affecting symptoms in young adults with L5 spondylolysis. OVERVIEW OF LITERATURE: L5 spondylolysis is a common disease. However, not all patients diagnosed with L5 spondylolysis exhibit symptoms. This study examined the factors associated with the symptoms of young adults with L5 spondylolysis. METHODS: The medical records of 70 young adults (mean age, 31.1 years; range, 20–39 years) with L5 spondylolysis treated at the authors’ spine center between March 2008 and February 2015 were reviewed systematically. The symptomatic group (n=46) presented with symptoms, such as back pain and/or intermittent lower limb radiating pain, whereas the asymptomatic group (n=24) did not. Age, sex, body mass index (BMI), adjacent disc degeneration, facet degeneration, and measured spino-pelvic parameters (pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, sacral inclination, and sacral table angle) were investigated with respect to the presence of symptoms. Adjacent disc degeneration was evaluated using T2-weighted sagittal magnetic resonance imaging (MRI, Pfirrmann classification), whereas facet degeneration was evaluated using T2-weighted axial MRI (Grogan classification). RESULTS: Significant differences in the BMI (p =0.032), L4–5 disc degeneration (p =0.030), L5–S1 disc degeneration (p =0.046), L4–5 facet degeneration (p =0.041), and L5–S1 facet degeneration (p =0.027) were observed between the symptomatic and asymptomatic groups. However, multivariate logistic regression analysis revealed that L5–S1 disc degeneration (p =0.033) was the only significant factor. CONCLUSIONS: BMI and adjacent disc and facet degeneration may be associated with the manifestation of disease symptoms in young adults with L5 spondylolysis, and the likelihood of the patient exhibiting symptoms increases with increasing severity of L5–S1 disc degeneration.