Atypical, unusual, and misleading imaging presentations of spondylolysis

Although lumbar spondylolysis is a widely known and easily recognizable condition in its typical presentation, there are some less well-known forms that may occasionally be challenging and/or demand special attention on imaging. Examples include: acute and/or incomplete lesions; unilateral defects; lesions at unusual levels (cervical, upper lumbar, and multi-level spondylolyses); iatrogenic lesions; non-isthmic spondylolysis; and spondylolysis related to underlying diseases. In addition to their atypical, uncommon or confusing imaging presentations, these forms of spondylolysis are far rarer than the classic type and have been described, to a great extent, in the surgical literature, thus reducing the awareness of radiologists about them and raising the potential for misdiagnosis and inadequate treatment. In this review the authors address these special manifestations of spondylolysis, stressing the more important features to be considered in the differential diagnosis and the impact of a precise diagnosis of spondylolysis on the patient's care.