Conservative treatment of lumbar spondylolysis in childhood and adolescence: the radiological signs which predict healing.
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.
Sairyo
K
K
Department of Orthopaedics, University of Tokushima School of Medicine, 3-18-15, Kuramoto, Tokushima 770-8503, Japan. sairyokun@hotmail.com
Sakai
T
T
Yasui
N
N
D000293:Adolescent; D001915:Braces; D002648:Child; D005260:Female; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D008297:Male; D011542:Pseudarthrosis / Q000175:diagnosis / Q000628:therapy; D016103:Spinal Fractures / Q000175:diagnosis / Q000628:therapy*; D013169:Spondylolysis / Q000175:diagnosis / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome