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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).

The Journal of the American Academy of Orthopaedic Surgeons
|April 15, 2025
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Summary

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.

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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.