Current Evidence Regarding Diagnostic Imaging Methods for Pediatric Lumbar Spondylolysis: A Report From the Scoliosis Research Society Evidence-Based Medicine Committee
Tóm tắt
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. 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. 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. 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.
Tài liệu tham khảo
Amato M, Totty WG, Gilula LA. Spondylolysis of the lumbar spine: demonstration of defects and laminal fragmentation. Radiology 1984;153:627–9.
Stretch RA, Botha T, Chandler S, et al. Back injuries in young fast bowlers—a radiological investigation of the healing of spondylolysis and pedicle sclerosis. S Afr Med J 2003;93:611–6.
Teplick JG, Laffey PA, Berman A, et al. Diagnosis and evaluation of spondylolisthesis and/or spondylolysis on axial CT. AJNR Am J Neuroradiol 1986;7:479–91.
Bellah RD, Summerville DA, Treves ST, et al. Low-back pain in adolescent athletes: detection of stress injury to the pars interarticularis with SPECT. Radiology 1991;180:509–12.
Elliott S, Hutson MA, Wastie ML. Bone scintigraphy in the assessment of spondylolysis in patients attending a sports injury clinic. Clin Radiol 1988;39:269–72.
Iwamoto J, Abe H, Tsukimura Y, et al. Relationship between radiographic abnormalities of lumbar spine and incidence of low back pain in high school and college football players: a prospective study. Am J Sports Med 2004;32:781–6.
Iwamoto J, Abe H, Tsukimura Y, et al. Relationship between radiographic abnormalities of lumbar spine and incidence of low back pain in high school rugby players: a prospective study. Scand J Med Sci Sports 2005;15:163–8.
Iwamoto J, Takeda T, Wakano K. Returning athletes with severe low back pain and spondylolysis to original sporting activities with conservative treatment. Scand J Med Sci Sports 2004;14:346–51.
Beck NA, Miller R, Baldwin K, et al. Do oblique views add value in the diagnosis of spondylolysis in adolescents? J Bone Joint Surg Am 2013;95:e65.
Dunn AJ, Campbell RS, Mayor PE, et al. Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis. Skeletal Radiol 2008;37:443–50.
Grogan JP, Hemminghytt S, Williams AL, et al. Spondylolysis studied with computed tomography. Radiology 1982;145:737–42.
Congeni J, McCulloch J, Swanson K. Lumbar spondylolysis. A study of natural progression in athletes. Am J Sports Med 1997;25:248–53.
Campbell RS, Grainger AJ, Hide IG, et al. Juvenile spondylolysis: a comparative analysis of CT, SPECT and MRI. Skeletal Radiol 2005;34:63–73.
ICRP, Khong PL, Ringertz H, Donoghue V, et al. ICRP Publication 121: radiological protection in paediatric diagnostic and interventional radiology. Ann ICRP 2013;42:1–63.
National Cancer Institute. Radiation risks and pediatric computed tomography (CT): a guide for health care providers. Rockville, MD: National Cancer Institute; 2012.
Masci L, Pike J, Malara F, et al. Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis. Br J Sports Med 2006;40:940–6.
Cohen E, Stuecker RD. Magnetic resonance imaging in diagnosis and follow-up of impending spondylolysis in children and adolescents: early treatment may prevent pars defects. J Pediatr Orthop B 2005;14:63–7.
Ganiyusufoglu AK, Onat L, Karatoprak O, et al. Diagnostic accuracy of magnetic resonance imaging versus computed tomography in stress fractures of the lumbar spine. Clin Radiol 2010;65:902–7.
Sairyo K, Katoh S, Takata Y, et al. MRI signal changes of the pedicle as an indicator for early diagnosis of spondylolysis in children and adolescents—a clinical and biomechanical study. Spine 2006;31:206–11.
Hollenberg GM, Beattie PF, Meyers SP, et al. Stress reactions of the lumbar pars interarticularis: the development of a new MRI classification system. Spine (Phila Pa 1976) 2002;27:181–6.
van den Oever M, Merrick MV, Scott JH. Bone scintigraphy in symptomatic spondylolysis. J Bone Joint Surg Br 1987;69:453–6.
Collier BD, Johnson RP, Carrera GF, et al. Painful spondylolysis or spondylolisthesis studied by radiography and single-photon emission computed tomography. Radiology 1985;154:207–11.
Jackson DW, Wiltse LL, Dingeman RD, et al. Stress reactions involving the pars interarticularis in young athletes. Am J Sports Med 1981;9:304–12.
Lowe J, Schachner E, Hirschberg E, et al. Significance of bone scintigraphy in symptomatic spondylolysis. Spine (Phila Pa 1976) 1984;9:653–5.
Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med 2007;357:2277–84.
Giordano BD, Grauer JN, Miller CP, et al. Radiation exposure issues in orthopaedics. J Bone Joint Surg Am 2011;93:e69.
Miller R, Beck NA, Sampson NR, et al. Imaging modalities for low back pain in children: a review of spondyloysis and undiagnosed mechanical back pain. J Pediatr Orthop 2013;33:282–8.