1/30/2024 0 Comments Bilateral l5 spondylolysisThe reader is fully responsible for confirming the accuracy of this content. Modality: Conventional Radiograph, MR, Nuc Med Access Level: Readable by all users, writable by NucMed Certifiers 2nd ed.Ĭase Number: 303259 Owner(s): Keith Fischer and Archana Kantawala Last Updated: 02-07-2013Īnatomy: Skeletal System Pathology: Trauma Helms CA. Fundamentals of Skeletal Radiology. Harvey CJ, Richenberg JL, Saifuddin A, Wolman RL. The radiological investigation of lumbar spondylolysis. The most accepted protocol includes activity and exercise that reduces extension stress. Physical therapy is an integral part of the patient's rehabilitation process. If the bone scan is normal, it implies that the healing is complete and that bracing is of limited use in patient mangement. This finding may imply the need for bracing. These findings indicate an acute process. Axial images will show absence of a complete bony ring at any given vertebral level.īone scintigraphy - increased activity in the pars interarticularis. Ocassionally, fragmentation of the pars interarticularis may be seen. If a pars defect is found with increased signal on T2, this indicates a subacute process.ĬT - linear lucency or defect extending through the pars interarticularis. On T2 images, signal may be decreased in the pars if the process is chronic, indicating reactive sclerosis. In cases with an actual fracture of the pars interarticularis, there is discontinuity or fragmentation of the pars interarticularis best seen on sagittal T1 images. On T1 images, there is decreased signal in the pars interarticularis. MRI - findings vary depending on the timing of the examination -In acute stress reaction there is increased signal on T2 images in the pars interarticularis representing marrow edema. MR imaging should be performed in thin sections at high resolution and in at least two planes - saggital and axial. MRI, CT or SPECT bone imaging are other imaging options that should be considered for further evaluation or if plain radiographs are inconclusive. Secondary signs on plain films - sclerosis of the contralateral pedicle and the presence of spina bifida occulta at the level of the lysis. This lucency also can be seen on oblique radiographs. Plain films- spondylolysis appears as a linear lucency in the pars interarticularis (see the images below). Lateral views are most sensitive and oblique views are most specific for detecting the pars defect. Patients with suspected spondylolysis should initially be evaluated with plain films - AP, lateral and oblique views. Spondylolysis is a defect in the pars interarticularis that may or may not be accompanied by forward translation of one vertebra relative to another (spondylolisthesis) Increased activity in the region of the pars may also be seen in infections, osteoid osteoma or degenerative changes.įalse negative- Chronic spondylolysis or old healed defects may not show increased activity.ĭiagnosis: Acute bilateral healing fracture at L5- S1. Plain films -Bilateral pars interarticularis defects at L5 with grade 1 anterolisthesis of L5 on S1.īone scintigraphy - Increased activity in the bilateral L5-S1 pars interarticularis fractures compatible with continued healing from acute fracture. MR- Bilateral pars interarticularis defects with the right side demonstrating spondylolysis. History: 16 year old patient: baseball player with back pain. Return to Case List with Diagnoses or Case List as Unknowns
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