Imaging assessment of pars interarticularis injury in young athletes with back pain: current concepts and imaging methods
Tóm tắt
Injury of the pars interarticularis is a common cause of low back pain, particularly in adolescent athletes. It is a spectrum of disease where repetitive bone stress and micro-trauma create an unstable fracture of the pars interarticularis (spondylolysis) that can ultimately lead to slippage of one vertebral body on another (spondylolisthesis). Radiographs are typically the initial study performed to evaluate patients with low back pain from suspected pars interarticularis injury and may identify structural abnormalities as well as the extent of vertebral body slippage. MRI may be helpful in certain cases since it is sensitive for soft tissue disease and can exclude other causes of back pain such as degenerative disk disease, infection or malignancy, although these are rare in young athletes. Skeletal scintigraphy is helpful in the evaluation of pars interarticularis injury since bone stress is the earliest form of disease and may be present before structural changes have occurred or are detected by anatomic imaging. Furthermore, patients with bone stress who have not yet developed structural abnormalities can receive early intervention with high probability of a good outcome. Skeletal scintigraphy should include planar images as well as single photon emission computed tomography (SPECT) of the spine. SPECT of the spine has greater contrast and sensitivity than planar skeletal scintigraphy and provides better anatomic localization of bone stress. Spine CT is helpful for the evaluation of patients with suspected pars interar ticularis injury since it provides high-resolution anatomic detail, confirms the diagnosis, identifies spondylolysis and evaluates the extent of ver tebral body slippage.
Tài liệu tham khảo
Standaert C, Herring S (2007) Expert opinion and controversies in sports and musculoskeletal medicine: The diagnosis and treatment of spondylolysis in adolescent athletes. Arch Phys Med Rehabil 88: 537–540
Micheli LJ, Wood R (1995) Back pain in young athletes. Significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med 149: 15–18
Micheli LJ, Curtis C (2006) Stress fractures in the spine and sacrum. Clin Sports Med 25(1): 75–88 ix
Tallarico RA, Madom IA, Palumbo MA (2008) Spondylolysis and spondylolisthesis in the athlete. Sports Med Arthrosc Rev 16(1): 32–38
Masci L, Pike J, Malara F, et al (2006) Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis. Br J Sports Med 40: 940–946
Standaert C, Herring S (2000) Spondylolysis: a critical review. Br J Sports Med 34: 415–422
Fellander-Tsai L, Micheli LJ (1998) Treatment of spondylolysis with external electrical stimulation and bracing in adolescent athletes: a report of 2 cases. Clin J Sport Med 8(3): 232–234
Pettine KA, Salib RM, Walker SG (1993) External electrical stimulation and bracing for treatment of spondylolysis. A case report. Spine 18(4): 436–439
Motley G, Nyland J, Jacobs J, et al (1998) The pars interarticularis stress reaction, spondylolysis, and spondylolisthesis progression. J Athl Train 33(4): 351–358
Takemitsu M, Rassi G, Woratanarat P, et al (2006) Low back pain in pediatric athletes with unilateral tracer uptake at the pars interarticularis on single photon emission computed tomography. Spine 31(8): 909–914
Anderson K, Sarwark J, Conway J, et al (2000) Quantitative assessment with SPECT imaging of stress injuries of the pars interarticularis and response to bracing. J Pediatr Orthop 20(1): 28–33
Pennell R, Maurer A, Bonakdarpour A (1985) Stress injuries of the pars interarticularis: radiologic classification and indications for scintigraphy. Am J Roentgenol 145: 763–766
Collier B, Johnson R, Carrera G, et al (1985) Painful spondylolysis or spondylolisthesis studied by radiography and single-photon-emission computed tomography. Radiology 154: 207–211
Bellah R, Summerville D, Treves S, et al (1991) Low-back pain in adolescent athletes: detection of stress injury to the pars interarticularis with SPECT. Muskuloskeletal Radiology 180: 509–512
Harvey C, Richenberg J, Saifuddin A, et al (1998) Pictorial review: the radiological investigation of lumbar spondylolysis. Clin Radiol 53: 723–728
Sarikaya I, Sarikaya A, Holder L (2001) The role of single photon emission computed tomography in bone imaging. Semin Nucl Med 31(1): 3–16.
Even-Sapir E, Metser U, Mishani E, et al (2006) The detection of bone metastasis in patients with high-risk prostate cancer: 99mTc-MDP planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-Fluoride PET, and 18F-Fluoride PET/CT. J Nucl Med 47(2): 287–297
Strobel K, Burger C, Seifert B, et al (2007) Characterization of focal bone lesions in the axial skeleton: performance of planar bone scintigraphy compared with SPECT and SPECT fused with CT. Am J Roentgenol 188: W467–474
Maeseneer M, Lenchik L, Everaert H, et al (1999) Evaluation of lower back pain with bone scintigraphy and SPECT. Radiographics 19: 901–912
Lim R, Fahey FH, Drubach LA, et al (2007) Early experience with 18F sodium fluoride bone PET in young patients with back pain. J Pediatr Orthop 27(3): 277–282
Grant FD, Fahey FH, Packard AB, et al (2008) Skeletal PET with 18F-fluoride: applying new technology to an old tracer. J Nucl Med 49(1): 68–78
Congeni J, McCulloch J, Swanson K (1997) Lumbar Spondylolysis: a study of natural progression in athletes. Am J Sports Med 25(2): 248–253
Morita T, Ikata T, Katoh S, et al (1995) Lumbar spondylolysis in children and adolescents. J Bone Joint Surg 77(4): 620–625
Brenner D, Hall E (2007) Computed Tomography — An increasing source of radiation exposure. N Engl J Med 357: 2277–2284
Campbell R, Grainger A, Hide I, et al (2005) Juvenile spondylolysis: a comparative analysis of CT, SPECT, and MRI. Skelet Radiol 34: 63–73
Gregory P, Batt M, Kerslake R, et al (2004) The value of combining single photon emission computerized tomography and computerized tomography in the investigation of spondylolysis. Eur Spine J 13: 503–509