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CT-Based Characterization of Fracture Patterns in Pediatric Lumbar Spondylolysis
Vivien Chan1,2, Robert G Watkins1, Kenneth D Illingworth1
1Cedars Sinai Spine, Cedars Sinai Medical Center, Los Angeles, California.
JB & JS Open Access
|November 24, 2025
Summary
Pediatric spondylolysis fracture patterns vary, often occurring one-third from the superior pars edge. Understanding these specific fracture characteristics can refine surgical techniques for better outcomes in pediatric patients.
Area of Science:
- Orthopedic surgery
- Pediatric spine disorders
- Radiology
Background:
- Spondylolysis is a stress fracture of the pars interarticularis.
- Precise fracture morphology is crucial for surgical management decisions, including direct repair feasibility.
- Characterizing fracture patterns in pediatric patients is essential for optimizing treatment.
Purpose of the Study:
- To characterize the specific fracture patterns of the pars interarticularis in pediatric patients with spondylolysis.
- To provide detailed measurements of fracture location, size, and angle.
- To correlate fracture morphology with potential surgical approaches.
Main Methods:
- Retrospective cohort study of pediatric patients (<21 years) with lumbar spondylolysis or Grade 1 isthmic spondylolisthesis.
- Computed tomography (CT) imaging was used for analysis.
- Measurements included total pars length, fracture gap size, and fracture angle relative to the pars long axis.
Main Results:
- 32 patients with 59 total spondylolyses were analyzed.
- Mean pars fracture angle was 110°-140° (68%), with significant variability.
- Fractures commonly occurred approximately one-third from the superior pars edge, but with considerable variation.
Conclusions:
- Significant variability exists in pediatric pars interarticularis fracture patterns.
- Detailed understanding of these patterns may refine surgical techniques.
- Improved characterization can lead to better surgical outcomes for pediatric spondylolysis.
