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Lumbar Spondylolysis in the Pediatric Population: A Retrospective CT Review With Radiology Rereview
Anna J Rambo1, Benjamin W Sheffer, Blake Hajek
1From the Department of Orthopedics and Sports Medicine, Nemours Children's Health, Jacksonville, FL (Rambo), the Department of Health Promotion and Disease Prevention, University of Tennessee Health Science Center, Memphis, TN (Hajek, Almatari, Rhodes, and Cao), the Le Bonheur Children's Hospital, Memphis, TN (Rhodes), the Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN (Sheffer, Warner, Sawyer, Kelly, and Spence), and the Baptist Memorial Hospital, Radiology Residency Program, Memphis, TN (Suit).
Insights
Lumbar spondylolysis, a defect in the pars interarticularis, affects 3.68% of children. Prevalence increases with age, particularly in older adolescents, and varies by race.
Area of Science:
- Pediatric radiology
- Orthopedic research
- Spinal imaging analysis
Background:
- Spondylolysis, a pars interarticularis defect, affects 4% of children and 6% of adults.
- This condition can be symptomatic or asymptomatic.
Purpose of the Study:
- To determine the prevalence of lumbar spondylolysis in children using CT scans.
- To identify patient-specific risk factors associated with pediatric spondylolysis.
Main Methods:
- Retrospective review of 1,931 abdominopelvic CT scans in patients up to 18 years old (2017-2020).
- Analysis included radiology reports and radiologist overreads, with demographic data and CT indications.
- Firth bias-reduced logistic regression modeled spondylolysis prevalence against demographic variables.
Main Results:
- Spondylolysis prevalence was 3.68% (71/1931) on radiologist overread, lower than prior literature.
- Prevalence increased with age: 0.41% (0-6 yrs), 1.58% (7-10 yrs), 3.59% (11-13 yrs), and 5.1% (14-18 yrs).
- White children had higher rates (5.06%) than Black children (2.05%); Black children were less likely to have spondylolysis (OR 0.4).
Conclusions:
- Pediatric lumbar spondylolysis prevalence is 3.68%, lower than previously reported.
- Increasing prevalence with age suggests development over time, possibly due to repetitive stress.
- Further research into age-related and race-related differences in pediatric spondylolysis is warranted.
Introduction:
Spondylolysis, a defect in the pars interarticularis, can be symptomatic or asymptomatic with an estimated prevalence of 4% by age 6 years and 6% by adulthood. This study's goal was to determine the prevalence of lumbar spondylolysis found on CT scans in children and to characterize patient-specific risk factors.
Methods:
Abdominopelvic CT scans done (2017 to 2020) in patients up to age 18 years were reviewed. The radiology report was retrospectively reviewed for a spondylolysis, and a radiologist rereviewed the CT scan. Patient demographics and indications for CT scan were included. Firth bias-reduced logistic regression was used to model spondylolysis with each demographic variable as a predictor.
Results:
One thousand nine hundred thirty-one CT reports and imaging were reviewed; abdominal pain (41.91%) and trauma (29.46%) were the most common reasons for CT scan. Spondylolysis was found in 42 patients (2.18%) per the radiology report and in 71 patients (3.68%) on radiologist overread. Median age was 13 years (interquartile range, 10 to 16 years). Age groups had the following prevalence: 0 to 6 years (0.41%); 7 to 10 years (1.58%); 11 to 13 years (3.59%); 14 to 18 years (5.1%). Increased prevalence was found in ages 14 to 18 years that was statistically significant (odds ratio 1; P = 0.0004). L5 was the most common level; most defects were bilateral. White patients had a higher rate of spondylolysis (5.06%) than Black patients (2.05%). Black patients were less likely to have a spondylolysis with an OR of 0.4 (0.22 to 0.69; P = 0.0007).
Discussion:
This study demonstrated a lower prevalence of lumbar spondylolysis (3.68%) in children compared with the previous literature. Increasing prevalence with age suggests that spondylolysis develops over time, likely because of repetitive stress. Future studies should characterize these age-related and race-related differences for better understanding.
Level Of Evidence:
Level IV, retrospective.
