What is the role of CT scan in the workup of pars interarticularis injury?

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

As with the above mentioned radionuclide studies, CT scanning has been found to be more sensitive than plain radiography in visualizing spondylolytic lesions. [48, 49]

In a study comparing plain radiography, CT scanning, and bone scintigraphy (either bone scan or SPECT), CT scanning was found to be more sensitive than plain radiographs, as well as more specific than radionuclide imaging. Both standard axial views and reverse gantry CT imaging were used for this study, and the authors noted that some pars interarticularis defects were seen more clearly with one versus the other, although a direct comparison of views was not made.

CT scanning has the added benefit of providing more detail about the nature of the pars interarticularis defect than bone scanning or SPECT scanning does. CT scanning has the advantage of visualizing other spinal pathologies, most notably intervertebral disc pathology, which is not seen on the other radionuclide imaging studies. The relationship between CT scanning and SPECT scanning has not been fully established, and it is presently unclear as to which is the more sensitive study. The role of CT scanning may be as an adjunctive study investigating the stage of healing in a pars fracture.

Yamane et al described a 4-stage grading system based on CT scan findings: nonlysis, prefissure, fissure, and pseudoarthrosis. [50]


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