title: Current Evidence Regarding Diagnostic Imaging Methods for Pediatric Lumbar Spondylolysis: A Report From the Scoliosis Research Society Evidence-Based Medicine Committee.
abstract: Spondylolysis is common among the pediatric population, yet no formal systematic literature review regarding diagnostic imaging has been performed. The Scoliosis Research Society (SRS) requested an assessment of the current state of peer reviewed evidence regarding pediatric spondylolysis.
  
  
  
  Literature was searched professionally and citations retrieved. Abstracts were reviewed and analyzed by the SRS Evidence-Based Medicine Committee. Level I studies were considered to provide Good Evidence for the clinical question. Level II or III studies were considered Fair Evidence. Level IV studies were considered Poor Evidence. From 947 abstracts, 383 full texts reviewed. Best available evidence for the questions of diagnostic methods was provided by 27 studies: no Level I sensitivity/specificity studies, five Level II and two Level III evidence, and 19 Level IV evidence.
  
  
  
  Pain with hyperextension in athletes is the most widely reported finding in history and physical examination. Plain radiography is considered a first-line diagnostic test for suspected spondylolysis, but validation evidence is lacking. There is consistent Level II and III evidence that pars defects are detected by advanced imaging in 32% to 44% of adolescents with spondylolysis based on history and physical. Level III evidence that single-photon emission computed tomography (SPECT) is superior to planar bone scan and plain radiographs but limited by high rates of false-positive and false-negative results and by high radiation dose. Computed tomography (CT) is considered the gold standard and most accurate modality for detecting the bony defect and assessment of osseous healing but exposes the pediatric patient to ionizing radiation. Magnetic resonance imaging (MRI) is reported to be as accurate as CT and useful in detecting early stress reactions of the pars without a fracture.
  
  
  
  Plain radiographs are widely used as screening tools for pediatric spondylolysis. CT scan is considered the gold standard but exposes the patient to a significant amount of ionizing radiation. Evidence is fair and promising that MRI is comparable to CT.
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA.
authors.forename: Charles G T
authors.initials: CG
authors.lastname: Ledonio
authors.affiliation: Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3017, Kansas City, KS 66160, USA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Burton
authors.affiliation: Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA. Electronic address: chcraw01@gmail.com.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Crawford
authors.affiliation: Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO 80205, USA.
authors.forename: Robert Shay
authors.initials: RS
authors.lastname: Bess
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110, USA.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Buchowski
authors.affiliation: Department of Orthopaedic Surgery, Stanford School of Medicine, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, USA.
authors.forename: Serena S
authors.initials: SS
authors.lastname: Hu
authors.affiliation: Department of Orthopaedic Surgery, New York University Langone Medical Center, 820 2nd Avenue, Suite 7A, New York, NY 10017, USA.
authors.forename: Baron S H
authors.initials: BS
authors.lastname: Lonner
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Polly
authors.affiliation: Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA 22908, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Sanders
mesh_terms: D002648:Child; D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D011859:Radiography / Q000379:methods / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D012955:Societies, Medical; D013169:Spondylolysis / Q000000981:diagnostic imaging*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods / Q000706:statistics & numerical data*
keywords: Diagnostic imaging; Pediatric spondylolysis; Systematic review