Juvenile spondylolysis: a comparative analysis of CT, SPECT and MRI
- 1k Downloads
To evaluate whether MRI correlates with CT and SPECT imaging for the diagnosis of juvenile spondylolysis, and to determine whether MRI can be used as an exclusive image modality.
Design and patients
Juveniles and young adults with a history of extension low back pain were evaluated by MRI, CT and SPECT imaging. All images were reviewed blindly. Correlative analyses included CT vs MRI for morphological grading and SPECT vs MRI for functional grading. Finally, an overall grading system compared MRI vs CT and SPECT combined. Statistical analysis was performed using the kappa statistic.
Seventy-two patients (mean age 16 years) were recruited. Forty pars defects were identified in 22 patients (31%), of which 25 were chronic non-union, five acute complete defects and ten acute incomplete fractures. Kappa scores demonstrated a high level of agreement for all comparative analyses. MRI vs SPECT (kappa: 0.794), MRI vs CT (kappa: 0.829) and MRI vs CT/SPECT (kappa: 0.786). The main causes of discrepancy were between MRI and SPECT for the diagnosis of stress reaction in the absence of overt fracture, and distinguishing incomplete fractures from intact pars or complete defects.
MRI can be used as an effective and reliable first-line image modality for diagnosis of juvenile spondylolysis. However, localised CT is recommended as a supplementary examination in selected cases as a baseline for assessment of healing and for evaluation of indeterminate cases.
KeywordsSpondylolysis Pars interarticularis Magnetic resonance imaging Computed tomography Single photon emission computed tomography
The authors would like to gratefully thank all the radiography staff in MRI and CT and the technicians in nuclear medicine for their enduring support during this study. Many thanks
- 1.Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 1984;66(5):699–707.Google Scholar
- 2.Wiltse LL, Widell EH Jr, Jackson DW. Fatigue fracture: the basic lesion is isthmic spondylolisthesis. J Bone Joint Surg Am 1975;57(1):17–22.Google Scholar
- 4.Wiltse LL, Newman PH, Macnab I. Classification of spondylolisis and spondylolisthesis. Clin Orthop 1976 (117):23–29.Google Scholar
- 6.Gundry CR, Fritts HM Jr. MR imaging of the spine in sports injuries. Magn Reson Imaging Clin N Am 1999;7(1):85–103.Google Scholar
- 8.Libson E, Bloom RA, Dinari G, et al. Oblique lumbar spine radiographs: importance in young patients. Radiology 1984;161:98–90.Google Scholar
- 12.Langston JW, Gavant ML. “Incomplete ring” sign: a simple method for CT detection of spondylolysis. J Comput Assist Tomogr 1985;9:726–729.Google Scholar
- 15.Saifuddin A, Burnett SJ. The value of lumbar spine MRI in the assessment of the pars interarticularis. Clin Radiol 1997;52(9):666–671.Google Scholar
- 16.Johnson DW, Farnum GN, Latchaw RE, Erba SM. MR imaging of the pars interarticularis. AJR Am J Roentgenol 1989;152(2):327–332.Google Scholar
- 17.Campbell RS, Grainger AJ. Optimization of MRI pulse sequences to visualize the normal pars interarticularis. Clin Radiol 1999;54(1):63–68.Google Scholar
- 18.Ulmer JL, Elster AD, Mathews VP, Allen AM. Lumbar spondylolysis: reactive marrow changes seen in adjacent pedicles on MR images. AJR Am J Roentgenol 1995;164(2):429–433.Google Scholar
- 19.Udeshi UL, Reeves D. Routine thin slice MRI effectively demonstrates the lumbar pars interarticularis. Clin Radiol 1999;54(9):615–619.Google Scholar
- 20.Hollenberg GM, Beattie PF, Meyers SP, Weinberg EP, Adams MJ. Stress reactions of the lumbar pars interarticularis: the development of a new MRI classification system. Spine 2002;27(2):181–186.Google Scholar
- 21.Altman DG. Practical statistics for medical research. In: London: Chapman and Hall; 1991. p. 403–409.Google Scholar
- 22.Beutler WJ, Fredrickson BE, Murtland A, Sweeney CA, Grant WD, Baker D. The natural history of spondylolysis and spondylolisthesis: 45-year follow-up evaluation. Spine 2003;28(10):1027–1035; discussion 1035.Google Scholar
- 23.Grenier N, Kressel HY, Schiebler ML, Grossman RI. Isthmic spondylolysis of the lumbar spine: MR imaging at 1.5 T. Radiology 1989;170(2):489–493.Google Scholar
- 25.Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994;331(2):69–73.Google Scholar
- 26.Micheli LJ, Wood R. Back pain in young athletes. Significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med 1995;149(1):15–18.Google Scholar
- 27.Ralston S, Weir M. Suspecting lumbar spondylolysis in adolescent low back pain. Clin Pediatr (Phila) 1998;37(5):287–293.Google Scholar
- 32.Rauch RA, Jinkins JR. Lumbosacral spondylolisthesis associated with spondylolysis. Neuroimaging Clin N Am 1993;3:543–555.Google Scholar