Conservative treatment of lumbar spondylolysis in childhood and adolescence: the radiological signs which predict healing

J Bone Joint Surg Br. 2009 Feb;91(2):206-9. doi: 10.1302/0301-620X.91B2.21256.

Abstract

It has been noted that bony union of a pars defect can be achieved in children if they wear a trunk brace. Our aim was to evaluate how the stage of the defect on CT and the presence or absence of high signal change in the adjacent pedicle on T2-weighted MRI were related to bony healing. We treated 23 children conservatively for at least three months. There were 19 boys and four girls with a mean age of 13.5 years (7 to 17). They were asked to refrain from sporting activity and to wear a Damen soft thoracolumbosacral type brace. There were 41 pars defects in 23 patients. These were classified as an early, progressive or terminal stage on CT. The early-stage lesions had a hairline crack in the pars interarticularis, which became a gap in the progressive stage. A terminal-stage defect was equivalent to a pseudarthrosis. On the T2-weighted MR scan the presence or absence of high signal change in the adjacent pedicle was assessed and on this basis the defects were divided into high signal change-positive or -negative. Healing of the defect was assessed by CT. In all, 13 (87%) of the 15 early defects healed. Of 19 progressive defects, only six (32%) healed. None of the seven terminal defects healed. Of the 26 high signal change-positive defects 20 (77%) healed after conservative treatment whereas none of the high signal change-negative defects did so. We concluded that an early-stage defect on CT and high signal change in the adjacent pedicle on a T2-weighted MR scan are useful predictors of bony healing of a pars defect in children after conservative treatment.

MeSH terms

  • Adolescent
  • Braces*
  • Child
  • Female
  • Fracture Healing / physiology
  • Humans
  • Lumbar Vertebrae / injuries*
  • Magnetic Resonance Imaging
  • Male
  • Pseudarthrosis / diagnosis
  • Pseudarthrosis / therapy
  • Spinal Fractures / diagnosis
  • Spinal Fractures / therapy*
  • Spondylolysis / diagnosis
  • Spondylolysis / therapy*
  • Tomography, X-Ray Computed
  • Treatment Outcome