Systematic Review.
To provide an evidence-based recommendation for when and how to employ imaging studies when diagnosing back pain thought to be caused by spondylolysis in pediatric patients.
Spondylolysis is a common structural cause of back pain in pediatric patients. The radiologic methods and algorithms used to diagnose spondylolysis are inconsistent among practitioners.
A literature review was performed in PubMed and Cochrane databases using the search terms "spondylolysis" "pediatric" "adolescent" "juvenile" "young" "lumbar" "MRI" "bone scan" "CT" and "SPECT". After inclusion criteria were applied, 13 articles pertaining to diagnostic imaging of pediatric spondylolysis were analyzed.
Ten papers included sensitivity calculations for comparing imaging performance. The average sensitivity of MRI with CT as the standard of reference was 81.4%. When compared to SPECT, the average sensitivity of CT was 85% and the sensitivity of MRI was 80%. Thirteen studies made a recommendation as to how best to perform diagnostic imaging of patients with clinically suspected spondylolysis. When compared to 2-view plain films, bone scans had 7-9 times the effective radiation dose while 4-view plain films and CT were approximately double. Of the diagnostic methods examined, MRI was the most expensive followed by CT, bone scan, 4-view plain films, and 2-view plain films.
Due to their efficacy, low cost, and low radiation exposure, we find 2-view plain films to be the best initial study. With unusual presentations or refractory courses, practitioners should pursue advanced imaging. MRI should be used in early diagnosis and CT in more persistent courses. However, the lack of rigorous studies makes it difficult to formulate concrete recommendations.
This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 January 2025.
All research outputs
#9,327,625
of 33,931,414 outputs
Outputs from Spine
#3,097
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Outputs of similar age
#106,929
of 354,603 outputs
Outputs of similar age from Spine
#45
of 143 outputs
Altmetric has tracked 33,931,414 research outputs across all sources so far. This one has received more attention than most of these and is in the 71st percentile.
So far Altmetric has tracked 9,947 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 7.2. This one has gotten more attention than average, scoring higher than 67% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 354,603 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 68% of its contemporaries.
We're also able to compare this research output to 143 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 67% of its contemporaries.
