Review of spondylolisthesis and spondylolysis in paediatric practice.
Presenting radiographs of 30 children with spondylolisthesis and spondylolysis were reviewed. A 67% incidence of spina bifida occulta was noted, a 13-fold increase of the incidence in the normal population, and a mechanism whereby this may precipitate a spondylolysis is given. The value of the spinous process rotation sign on AP radiographs and facet joint mal-alignment on oblique radiographs in paediatric practice was assessed, and the incidence was 39% and 56% respectively, compared with 92% and 91% in adult practice. Reasons for the reduced incidence are suggested. Oblique radiographs provided further diagnostic information only in the absence of a spondylolisthesis. Follow-up radiographs showed further slip in only five patients. The one constant factor in these five patients was the presence of a spina bifida occulta, indicating the necessity for close observation of such patients with a spondylolisthesis during the adolescent growth spurt. 99Tcm MDP bone scans were performed in three patients, in whom 4 of 5 spondylolyses were shown to have a high uptake. One lesion subsequently became of low uptake as symptoms subsided. Bone scanning in spondylolisthesis needs further evaluation but the finding of increased bone activity suggests a healing process. Spondylolysis is a differential diagnosis to be considered in a positive scan for evaluation of back pain.
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004164:Diphosphonates; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D011187:Posture; D011859:Radiography; D011877:Radionuclide Imaging; D012447:Sacrum / Q000000981:diagnostic imaging*; D016136:Spina Bifida Occulta / Q000000981:diagnostic imaging; D013168:Spondylolisthesis / Q000000981:diagnostic imaging*; D013169:Spondylolysis / Q000000981:diagnostic imaging*; D013667:Technetium; D013669:Technetium Tc 99m Medronate
D004164:Diphosphonates; D013667:Technetium; D013669:Technetium Tc 99m Medronate