How are the results of plain radiographs and SPECT used in treatment selection for pars interarticularis injuries?

Updated: Jan 22, 2019
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Answer

Below, table 1 outlines the interpretation of plain radiographs coupled with SPECT scan results.

Table 1 also offers treatment strategies based on these results, as followed by a British institution. [47] These treatment strategies were outlined in a study conducted jointly by the investigators' orthopedic and radiology departments, who investigated the role of SPECT scanning in the management of patients with back pain and spondylolysis. [47]

Although radionuclide imaging may have increased sensitivity in detecting pars defects compared with plain radiographs, they are not necessarily highly specific for this detection and have been found to yield positive results from pathologies other than spondylolysis, including a infection and tumor such as osteoid osteoma and osteoblastoma.

Table 1. Outline of the Treatment Strategy Based on Results of Plain Radiographs and SPECT Scanning in the Evaluation of Defects of the Pars Interarticularis in Patients Clinically Suspected of Having Symptomatic Pars Interarticularis Lesions (Open Table in a new window)

Plain Radiograph

SPECT Scan

Interpretation

Management

Negative

Negative

Pathology other than pars defect should be suspected

Further investigation of cause of back pain should be performed (eg, MRI)

Negative

Positive

Early pars interarticularis fracture

Conservative management in form of rest, +/– bracing

Positive

Healing

Spondylolysis

Conservative management in the form of rest and bracing

Positive

Negative

Pseudoarthrosis or old unhealed fracture

Consider surgical intervention for stabilization to prevent spondylolisthesis and to relieve pain. Consider further investigation to rule out alternative pathology.


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