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Imaging Pediatric Spondylolysis: A Systematic Review
Josef N Tofte1, Tyler L CarlLee1, Andrew J Holte2
1University of Iowa Hospitals and Clinics Department of Orthopaedics and Rehabilitation, Iowa City, IA.
Insights
Two-view plain films are recommended as the initial imaging study for pediatric spondylolysis due to their effectiveness, low cost, and minimal radiation exposure. Advanced imaging like MRI or CT may be considered for complex cases.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Orthopedic Surgery
Background:
- Spondylolysis is a frequent cause of back pain in children and adolescents.
- Current diagnostic imaging methods for pediatric spondylolysis lack consistency among practitioners.
Purpose of the Study:
- To provide evidence-based recommendations for the appropriate use of imaging studies in diagnosing pediatric spondylolysis.
- To guide practitioners on when and how to utilize various imaging modalities.
Main Methods:
- A systematic literature review was conducted using PubMed and Cochrane databases.
- Search terms included "spondylolysis," "pediatric," and various imaging modalities (MRI, CT, bone scan, SPECT).
- Thirteen articles on diagnostic imaging for pediatric spondylolysis were analyzed.
Main Results:
- Magnetic resonance imaging (MRI) showed an average sensitivity of 81.4% compared to computed tomography (CT).
- CT sensitivity was 85% and MRI sensitivity was 80% when compared to single-photon emission CT (SPECT).
- Two-view plain films involve significantly less radiation exposure than bone scans or CT, and are the least expensive imaging option.
Conclusions:
- Two-view plain films are the preferred initial imaging study for suspected pediatric spondylolysis due to efficacy, cost, and low radiation.
- Advanced imaging, such as MRI for early diagnosis and CT for persistent cases, should be considered for unusual or refractory presentations.
- The lack of high-quality studies currently limits the ability to establish definitive recommendations.
Study Design:
A systematic review.
Objective:
The aim of this study was to provide an evidence-based recommendation for when and how to employ imaging studies when diagnosing back pain thought to be caused by spondylolysis in pediatric patients.
Summary Of Background Data:
Spondylolysis is a common structural cause of back pain in pediatric patients. The radiologic methods and algorithms used to diagnose spondylolysis are inconsistent among practitioners.
Methods:
A literature review was performed in PubMed and Cochrane databases using the search terms "spondylolysis," "pediatric," "adolescent," "juvenile," "young," "lumbar," "MRI," "bone scan," "CT," and "SPECT." After inclusion criteria were applied, 13 articles pertaining to diagnostic imaging of pediatric spondylolysis were analyzed.
Results:
Ten papers included sensitivity calculations for comparing imaging performance. The average sensitivity of magnetic resonance imaging (MRI) with computed tomography (CT) as the standard of reference was 81.4%. When compared with single-photon emission CT (SPECT), the average sensitivity of CT was 85% and the sensitivity of MRI was 80%. Thirteen studies made a recommendation as to how best to perform diagnostic imaging of patients with clinically suspected spondylolysis. When compared with two-view plain films, bone scans had seven to nine times the effective radiation dose, while four-view plain films and CT were approximately double. Of the diagnostic methods examined, MRI was the most expensive followed by CT, bone scan, four-view plain films, and two-view plain films.
Conclusion:
Due to their efficacy, low cost, and low radiation exposure, we find two-view plain films to be the best initial study. With unusual presentations or refractory courses, practitioners should pursue advanced imaging. MRI should be used in early diagnosis and CT in more persistent courses. However, the lack of rigorous studies makes it difficult to formulate concrete recommendations.
Level Of Evidence:
3.
