Objective To introduce a novel risk factor for lumbar spondylolysis,the pedicle isthmus angle(PIA),and to explore its underlying mechanism and clinical relevance.Methods A retrospective analysis of CT imaging data from young male patients with lumbar spondylolysis,admitted to the 960th Hospital of the Joint Logistic Support Force of the PLA between January 2018 and August 2023,was conducted.The study included 119 cases of unilateral spondylolysis and 339 cases of bilateral spondy-lolysis,with a mean age of 22.8±3.4 years(range 18-30 years).A control group of 458 patients with normal lumbar CT scans,pre-senting with low back pain,was also analyzed.Their mean age was 22.9±3.5 years(range 18-30 years).The PIA of the left and right sides of the L3,L4,and Ls vertebrae in both the spondylolysis and control groups were measured using CT imaging.Differenc-es in PIA measurements between the left and right sides,as well as between groups,were compared.Binary logistic regression analysis identified risk factors for lumbar spondylolysis.The receiver operating characteristic(ROC)curve and Youden index were used to determine the critical risk threshold for lumbar spondylolysis.Results No significant differences were found between the spondylolysis and control groups in terms of gender,age,height,weight,or body mass index(BMI)(P＞0.05).Similarly,there was no significant difference in the left and right PIA measurements for the L3,L4,and Ls vertebrae in either group(P＞0.05).The PIA of the L3 and L4 vertebrae was not significantly different between the groups(107.2°±3.5° vs.107.1°±3.5°,t=0.270,P=0.787;110.6°±3.5° vs.110.5°±4.0°,t=0.441,P=0.659).However,the PIA of the Ls vertebra was significantly larger in the spondylolysis group(117.7°±4.7°)compared to the control group(114.0°±4.9°)(t=11.654,P＜0.001).Logistic regression analysis identified an in-creased PIA at L5(8=0.159,OR=1.172,P＜0.001)as a risk factor for lumbar spondylolysis.According to the ROC curve and Youden index,the risk of lumbar spondylolysis increased substantially when the Ls PIA exceeded 115.8°.The area under the curve(AUC)was 0.709,with a sensitivity of 0.670 and a specificity of 0.644.Conclusion PIA is an objective and effective imag-ing parameter for predicting lumbar spondylolysis.It aids in understanding the pathophysiology of spondylolysis,identifying high-risk individuals,and informing prevention and treatment strategies for lumbar spondylolysis.
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