The value of SPECT in the detection of stress injury to the pars interarticularis in patients with low back pain

Abstract

The medical cost associated with back pain in the United States is considerable and growing. Although the differential diagnosis of back pain is broad, epidemiological studies suggest a correlation between adult and adolescent complaints. Injury of the pars interarticularis is one of the most common identifiable causes of ongoing low back pain in adolescent athletes. It constitutes a spectrum of disease ranging from bone stress to spondylolysis and spondylolisthesis. Bone stress may be the earliest sign of disease. Repetitive bone stress causes bone remodeling and may result in spondylolysis, a non-displaced fracture of the pars interarticularis. A fracture of the pars interarticularis may ultimately become unstable leading to spondylolisthesis. Results in the literature support the use of bone scintigraphy to diagnose bone stress in patients with suspected spondylolysis. Single photon emission computed tomography (SPECT) provides more contrast than planar bone scintigraphy, increases the sensitivity and improves anatomic localization of skeletal lesions without exposing the patient to additional radiation. It also provides an opportunity for better correlation with other imaging modalities, when necessary. As such, the addition of SPECT to standard planar bone scintigraphy can result in a more accurate diagnosis and a better chance for efficient patient care. It is our expectation that by improving our ability to correctly diagnose bone stress in patients with suspected injury of the posterior elements, the long-term cost of managing this condition will be lowered.

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

“…A normal bone scan with pars defect is consistent with a healed (fibrous) process or non-union. The important prognostic value of bone scintigraphy makes it the most sensitive tool for the diagnosis of active spondylolysis in young athletes [5,[35][36][37][38][39]. Magnetic resonance imaging (MRI) is indicated when neurologic symptoms and signs are present.…”

Stres Fraktürüne Nükleer Tıp Yaklaşımı

“…Kemik SPECT görüntülemede multiple projeksiyonlarda gama kamera ile görüntüler alınır, RF' nin tüm iskelet sistemindeki dağılımının koronal, sagital ve aksiyal düzlemde gösterilmesini sağlar. Kemik SPECT ile ÜFKS' den yaklaşık 10-20 kat daha fazla görüntü kontrastı sağlanmış olur, ÜFKS' nin duyarlılığı artar, iskelet lezyonlarının daha doğru anatomik lokalizasyonu sağlanır [21][22][23][24] .…”

Frequency of spondylolysis and chronic low back pain in young soccer players

“…5,6,11 Most of the cases respond well clinically, even without radiographic changes, when compared to the initial condition. Refractory cases make up 5% of the total number of symptomatic patients 10 and surgery is indicated. Direct repair of the injury without arthrodesis and with simple blood irrigation of the focus and external immobilization, or compression with hooks and screws, is the preferred treatment, but cases with spondylolisthesis and significant instability make segmental arthrodesis necessary.…”

“…5,6,9 Its physiopathology has not been explained in detail, but the hypothesis that it is a stress fracture caused by excessive load is widely accepted. 4,10,11 Anatomical and biomechanical changes to the positioning of the sacrum in relation to the ground, the degree of lordosis, occult spina bifida, and family history are other possible factors in the development of this change. 6,9,12,13 Its prevalence in the general population is between 3% and 5% and in young athletes it can reach as high as 60%, depending on the sport involved.…”

“…6,9,12,13 Its prevalence in the general population is between 3% and 5% and in young athletes it can reach as high as 60%, depending on the sport involved. 6,14 Participants in impact sports or in sports with repetitive movements with mechanical-type low back pain (related to movement) that worsens with the extension and shortening of the ischiotibial muscles raise a clinical suspicion that can be confirmed through complementary exams: simple radiographies, computed tomography (CT), total body bone scintigraphy, mag-netic resonance imaging (MRI), and more recently, single-photon emission computed tomography (SPECT), 10,15 for some authors the gold standard for diagnosis 10 but still little used in our country. Radiculopathy is a rare symptom, but possible, due to the proximity of the nerve root to the inflammatory process.…”