![]() ![]() ![]() Mellado J, Larrosa R, Martín J, Yanguas N, Solanas S, Cozcolluela M. Lumbar Spondylolysis Without Spondylolisthesis: Recognition of Isolated Posterior Element Subluxation on Sagittal MR. Syrmou E, Tsitsopoulos P, Marinopoulos D, Tsonidis C, Anagnostopoulos I, Tsitsopoulos P. Spondylolysis, Spondylolisthesis, and Associated Nerve Root Entrapment in the Lumbosacral Spine: MR Evaluation. Jinkins J, Matthes J, Sener R, Venkatappan S, Rauch R. Incomplete fractures demonstrate good healing rates with conservative management 7. Surgery is only considered in rare circumstances as most cases respond to conservative management 2. Grade IV: chronic stress fracture MRI: no marrow edema fractures completely extending through pars interarticularis Grade III: acute complete stress fracture MRI: marrow edema complete cortical fracture extending through pars interarticularis Grade II: incomplete stress fracture MRI: marrow edema incomplete cortical fracture or fissure Grade I: stress reaction MRI: marrow edema intact cortical margins Grade 0: normal pars interarticularis MRI: no signal abnormality, pars interarticularis intact The Hollenberg classification system is based on MRI features but correlates well with SPECT-CT 6,7: Wide-canal sign may be present on sagittal images when there is spondylolisthesis 3 Scotty dog sign: on oblique radiographs, a break in the pars interarticularis can have the appearance of a collar around the dog's neck Limited sensitivity compared to SPECT and CT 4 CT is considered the gold standard although MRI should be used as the first-line imaging modality in adolescents 7. Imaging features depend on the age of the lesion. ~90% of cases of spondylolysis occur at the L5 level and ~10% occur at the L4 level 1,2 Traumatic pars defects result from high-energy trauma where there is hyperextension of the lumbar spine and are rare in a congenitally normal vertebra Repeated microtrauma, resulting in a stress injury and eventual fracture of the pars interarticularis a dysplastic pars is usually present Acquired defects have two main mechanisms: Developmental defects may develop in patients <10 years 7. Spondylolysis may be developmental or acquired. It is a common cause of low back pain in adolescents and may be the cause of low back pain in ~50% of adolescent athletes 7. Spondylolysis is commonly asymptomatic. Symptomatic patients often have pain with extension and/or rotation of the lumbar spine. Approximately 25% of individuals with spondylolysis have symptoms at some time. ~65% of patients with spondylolysis will progress to spondylolisthesis 2, which is seen radiographically in ~25% 4 in most patients, this occurs before the age of 16 Spondylolysis is present in ~5% of the population 2 and higher in the adolescent athletic population. It is more common in men than in women 1. ![]()
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