The nature of the spondylolytic defect. Demonstration of a communicating synovial pseudarthrosis in the pars interarticularis

J Bone Joint Surg Br. 1998 Jul;80(4):662-4. doi: 10.1302/0301-620x.80b4.8323.

Abstract

We injected methylene blue dye into 32 of the facet joints immediately above the defects in 17 consecutive patients with bilateral spondylolysis (34 defects). In 30 of these the dye flowed into a central cavity in the defect of the pars interarticularis and in 20 it passed into the facet joint below the defect. We found macroscopic cavities in 32 of the defects which communicated with the adjacent facet joints and had fibrous capsules. Histological examination showed focal areas of synovial lining consistent with a synovial pseudarthrosis. In most patients requiring surgery for spondylolysis, the defect is a synovial pseudarthrosis which communicates with the facet joint above it, and less often with the facet joint below it. We suggest that stress fractures of the pars may fail to heal because of the presence of synovial fluid from a nearby facet joint.

MeSH terms

  • Adult
  • Cartilage / pathology
  • Coloring Agents
  • Connective Tissue / pathology
  • Female
  • Fibrosis
  • Fracture Healing / physiology
  • Fractures, Stress / physiopathology
  • Humans
  • Ligamentum Flavum / pathology
  • Lumbar Vertebrae / pathology*
  • Male
  • Methylene Blue
  • Middle Aged
  • Pseudarthrosis / pathology*
  • Spondylolysis / pathology*
  • Synovial Fluid / physiology
  • Synovial Membrane / pathology*

Substances

  • Coloring Agents
  • Methylene Blue