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Current Evidence Regarding Diagnostic Imaging Methods for Pediatric Lumbar Spondylolysis: A Report From the Scoliosis Research Society Evidence-Based Medicine Committee

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Abstract

Background

Spondylolysis is common among the pediatric population, yet no formal systematic literature review regarding diagnostic imaging has been performed. The Scoliosis Research Society (SRS) requested an assessment of the current state of peer reviewed evidence regarding pediatric spondylolysis.

Methods

Literature was searched professionally and citations retrieved. Abstracts were reviewed and analyzed by the SRS Evidence-Based Medicine Committee. Level I studies were considered to provide Good Evidence for the clinical question. Level II or III studies were considered Fair Evidence. Level IV studies were considered Poor Evidence. From 947 abstracts, 383 full texts reviewed. Best available evidence for the questions of diagnostic methods was provided by 27 studies: no Level I sensitivity/specificity studies, five Level II and two Level III evidence, and 19 Level IV evidence.

Results

Pain with hyperextension in athletes is the most widely reported finding in history and physical examination. Plain radiography is considered a first-line diagnostic test for suspected spondylolysis, but validation evidence is lacking. There is consistent Level II and III evidence that pars defects are detected by advanced imaging in 32% to 44% of adolescents with spondylolysis based on history and physical. Level III evidence that single-photon emission computed tomography (SPECT) is superior to planar bone scan and plain radiographs but limited by high rates of false-positive and false-negative results and by high radiation dose. Computed tomography (CT) is considered the gold standard and most accurate modality for detecting the bony defect and assessment of osseous healing but exposes the pediatric patient to ionizing radiation. Magnetic resonance imaging (MRI) is reported to be as accurate as CT and useful in detecting early stress reactions of the pars without a fracture.

Conclusion

Plain radiographs are widely used as screening tools for pediatric spondylolysis. CT scan is considered the gold standard but exposes the patient to a significant amount of ionizing radiation. Evidence is fair and promising that MRI is comparable to CT.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA

    Charles G. T. Ledonio MD & David W. Polly Jr. MD

  2. Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3017, Kansas City, KS, 66160, USA

    Douglas C. Burton MD

  3. Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY, 40202, USA

    Charles H. Crawford III MD

  4. Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO, 80205, USA

    Robert Shay Bess MD

  5. Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO, 63110, USA

    Jacob M. Buchowski MD

  6. Department of Orthopaedic Surgery, Stanford School of Medicine, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063-6342, USA

    Serena S. Hu MD

  7. Department of Orthopaedic Surgery, New York University Langone Medical Center, 820 2nd Avenue, Suite 7A, New York, NY, 10017, USA

    Baron S. H. Lonner MD

  8. Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA, 22908, USA

    Justin S. Smith MD, PhD

  9. Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA

    James O. Sanders MD

Authors
  1. Charles G. T. Ledonio MD
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  2. Douglas C. Burton MD
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  3. Charles H. Crawford III MD
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  4. Robert Shay Bess MD
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  6. Serena S. Hu MD
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  7. Baron S. H. Lonner MD
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  8. David W. Polly Jr. MD
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  9. Justin S. Smith MD, PhD
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  10. James O. Sanders MD
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Corresponding author

Correspondence to Charles H. Crawford III MD.

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Author disclosures

CGTL (grants from Scoliosis Research Society, during the conduct of the study); DCB (personal fees from DePuy Spine; other from DePuy Spine; from University of Kansas Physicians, Inc [Board of Directors] and International Spine Study Group [Board of Directors], outside the submitted work); CHC (grants from Scoliosis Research Society, during the conduct of the study; personal fees from Alphatec, DePuy-Synthes and Medtronic, outside the submitted work); RSB (grants from DePuy Spine, during the conduct of the study; personal fees from Allosource, K2 Medical, NuVasive, and Allosource; grants from DePuy Spine and Medtronic; personal fees from Pioneer, outside the submitted work); JMB (personal fees from Advance Medical, CoreLink, Globus Medical, K2M, Medtronic, Stryker, Broadwater/Vertical Health, DePuy Synthes, Orthofix, and Wolters Kluwer Health; other from AO Foundation; grants from CSSG/K2M and OREF, outside the submitted work); SSH (none); BSHL (grants from Setting Scoliosis Straight Foundation, AO Spine, John and Marcella Fox Fund, and OREF; personal fees from DePuy Synthes, K2M, Spine Search, and Paradigm Spine; nonfinancial support from SRS Spine Deformity Journal, outside the submitted work); DWP (grants from Scoliosis Research Society, during the conduct of the study); JSS (personal fees and other from Biomet, NuVasive, and DePuy; personal fees from Cerapedics and Medtronic; other from AO Spine; grants and other from NREF, outside the submitted work); JOS (none).

Funding for this study was provided by the Scoliosis Research Society Evidence-Based Medicine Committee.

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Ledonio, C.G.T., Burton, D.C., Crawford, C.H. et al. Current Evidence Regarding Diagnostic Imaging Methods for Pediatric Lumbar Spondylolysis: A Report From the Scoliosis Research Society Evidence-Based Medicine Committee. Spine Deform 5, 97–101 (2017). https://doi.org/10.1016/j.jspd.2016.10.006

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  • DOI: https://doi.org/10.1016/j.jspd.2016.10.006

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