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Use of Multidetector CT in the Diagnosis of Spondylolysis 2004

Eubig, Jan, Dickson, Asante, M.D., Ortiz, Orlando, MD, MBA, Luchs, Jonathan, M.D., Katz, Douglas, M.D., Lustrin, Elizabeth, M.D.

Purpose:
Lumbar spondylolysis is a common, yet under diagnosed cause of lower back pain in patients. The diagnosis of spondylolysis often remains illusive when employing such modalities as plain radiography, single detector CT, MR I, and skeletal scintigraphy. A number of factors contribute to this diagnostic challenge including incomplete visualization of the pars interarticularis, coexisting facet joint degeneration, sclerosis of the pars interarticularis and the pedicle, and lack of associated spondylolisthesis. In our study we explore the efficacy of multidetector CT (MDCT) as an alternate modality in the diagnosis of lumbar spondylolysis.

Methods and Materials:
36 cases of spondylolysis were retrospectively reviewed. MDCT was utilized in 17 out of these 36 cases.

Results:
MDCT with its capacity for rapid multiplanar reformations showed significant accuracy in identifying and characterizing occult or suspected lumbar spondylolysis. The diagnosis of lumbar spondylolysis was made in all 17 patients who underwent examination with MDCT.

Conclusion:
Our study demonstrates multidetector CT is both sensitive and specific in identifying defects of the pars interarticularis.

References:

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2. Collier BD, Johnson RP, Carrera GF, et al. Painful spondylolysis or spondylolisthesis studied by radiography and single-photon emission computed tomography. Radiology 154:207-211, 1985.
3. Elster AD, Jensen KM. Importance of sagittally reformatted images in CT evaluation of spondylolisthesis. AJNR Am J Neuroradiol 7:1102, 1986.
4. Harvey CJ, Richenberg JL, Saifuddin A, Wolman RL. The radiological investigation of lumbar spondylolysis. Clin Radiol. 53(10):723-8, 1998