Learning objectives
The primary purposes of this educational exhibit were:
To illustrate the imaging principles for the diagnosis and follow-up of lumbar spondylolysis;
To discuss radiological features useful to differentiate between active and inactive conditions.
Background
Spondylolysis is an osseous defect of the pars interarticularis,
thought to be a developmental or acquired stress fracture secondary to chronic low-grade trauma (Fig. 1).
Pathogenesis
The mechanism of injury is usually a combination of repetitive flexion,
extension,
or rotation of the lumbar spine [1,
2].
In particular,
the pars interarticularis of L5 is sheared during extension by the inferior articular process of L4 and the superior articular process of the sacrum acting as a pair of wedges.
This mechanism leads to stretching of the...
Findings and procedure details
Neutral radiography
Spondylolysis refers to the radiolucent defect in the pars interarticularis.
The width of thegap depends on the degree of spondylolisthesis (Fig. 3).
Indirect signs of spondylolysis on the anteroposterior view include lateral deviation of the spinous process (which is difficult to determine) and sclerosis of the contralateral pedicle(Fig. 4).
Functional radiography
In symptomatic spondylolisthesis,
mobility at the pars defect is determined on functional flexion–extension radiography.
The type of sagittal rotation (variation of the angle between vertebral endplates adjacent to the disk) is more...
Conclusion
Diagnosis of stress reaction,
incomplete,
or complete acute fractures is important as fracture healing may be achieved with conservative treatment.
MR imagingshould be used as the first-line imaging modality for investigation of juvenile spondylolysis.
MDCT is the most accurate modality to detect the bony defect and may also be used for assessment of healing; however,
it is not sensitive for detection of the stress reaction and exposes the patient to ionizing radiation.
Unfortunately,
neither MR nor CT and SPECT imaging can reliably distinguish whether an...
Personal information
L.
Tonetti,
Instituteof Radiology,
Catholic University,
School of Medicine,
Largo A.
Gemelli 8,
00168,
Rome/Italy.
A.
Leone,
Instituteof Radiology,
Catholic University,
School of Medicine,
Largo A.
Gemelli 8,
00168,
Rome/Italy.
M.
Marino,
Instituteof Radiology,
Catholic University,
School of Medicine,
Largo A.
Gemelli 8,
00168,
Rome/Italy.
A.
Semprini,
Instituteof Radiology,
Catholic University,
School of Medicine,
Largo A.
Gemelli 8,
00168,
Rome/Italy.
V.
Zecchi,
Instituteof Radiology,
Catholic University,
School of Medicine,
Largo A.
Gemelli 8,
00168,
Rome/Italy.
C.
Colosimo,
Instituteof Radiology,
Catholic University,
School of Medicine,
Largo...
References
[1] Sugiura S,
Aoki Y,
Toyooka T,
et al.
Characteristics of Low Back Pain in Adolescent Patients With Early-Stage Spondylolysis Evaluated Using a Detailed Visual Analogue Scale.
Spine 2015;40(1):E29-E34.
[2] Sakai T,
Goda Y,
Tezuka F,
et al.
Characteristics of lumbar spondylolysis in elementary school age children.
Eur Spine J 2015.
[3] Mac-Thiong JM,
Labelle H,
Berthonnaud E,
Betz RR,
Roussouly P.
Sagittal spinopelvic balance in normal children and adolescents.
Eur Spine J.
2007;16(2):227-234.
[4] Metzger R,
Chaney S.
Spondylolysis and spondylolisthesis: What the primary...