Background:Previous studies have reported that spondylolysis occurs predominantly at the L5 and L4 levels, with defects at higher levels occurring in <5% of cases. However, computed tomography and radiography were the primary imaging modalities in these studies. Current evidence regarding diagnostic imaging for pediatric lumbar spondylolysis suggests that magnetic resonance imaging (MRI) is as accurate as computed tomography in detecting early stress reactions of the pars interarticularis or pedicles without fractures while avoiding radiation exposure. The early detection of spondylolysis results in a higher likelihood of bony union and a decreased likelihood of spondylolisthesis.Hypothesis:The increased use of MRI may reveal a larger proportion of spondylolysis in patients who experience an injury at a higher spinal level than previously reported.Study Design:Cross-sectional study; Level of evidence, 3.Methods:The medical records of 902 pediatric and adolescent athletes (364 female, 538 male) diagnosed with symptomatic pars interarticularis and pedicle stress injuries at 2 academic medical centers between 2016 and 2021 were retrospectively reviewed. All patients had MRI scans taken at the time of diagnosis. Only patients with pars/pedicle edema on MRI were included. Data regarding spondylolysis stage, spinal level of injury, unilateral versus bilateral injury, sport participation, and MRI protocol over the 5-year study period were analyzed.Results:Male patients presented at older ages than female patients ( P < .001). Soccer was the most common sport at symptom onset and the second most common single-sport activity among those who specialized (participating in 1 sport year-round at the exclusion of others), behind gymnastics. The mean symptom duration was 4.0 months. Although most patients (83.5%) had exclusively lower lumbar stress injuries, 9.1% of injuries occurred at or above the L3 level. Over half of the patients had active single-level pars/pedicle fractures on MRI, with a mean symptom duration before presentation in this subgroup of 4.0 months. Even when pars/pedicle stress reactions were excluded from analysis, 7.1% of patients were injured at or above the L3 level.Conclusion:Among male and female athletes aged 8 to 21 years presenting with symptomatic pars interarticularis and pedicle stress injuries evaluated by MRI at the time of initial diagnosis, there was a higher incidence of upper lumbar stress injuries than previously reported.

中文翻译：

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患有腰痛的年轻运动员的关节间部和椎弓根应力损伤：一项对 902 名患者进行磁共振成像评估的回顾性队列研究


背景：之前的研究表明，椎弓峡部裂主要发生在 L5 和 L4 水平，较高水平的缺陷发生率<5%。然而，计算机断层扫描和放射线照相是这些研究中的主要成像方式。目前关于小儿腰椎峡部裂诊断成像的证据表明，磁共振成像 (MRI) 在检测无骨折的关节间部或椎弓根的早期应激反应方面与计算机断层扫描一样准确，同时避免辐射暴露。早期发现椎弓峡部裂会导致骨性愈合的可能性更高，并降低脊椎滑脱的可能性。假设：MRI 的使用增加可能会揭示出比以前报道的脊柱水平更高的损伤患者中更大比例的椎弓峡部裂。研究设计：横断面研究；证据级别，3。方法：回顾性审查了 2016 年至 2021 年间在 2 个学术医疗中心诊断为症状性关节间肌和椎弓根应力损伤的 902 名儿童和青少年运动员（364 名女性，538 名男性）的医疗记录。所有患者在诊断时均进行了 MRI 扫描。仅纳入 MRI 显示经部/椎弓根水肿的患者。分析了 5 年研究期间有关椎弓峡部裂分期、脊柱损伤水平、单侧与双侧损伤、运动参与和 MRI 方案的数据。结果：男性患者的就诊年龄高于女性患者 ( P < .001)。足球是症状出现时最常见的运动，也是专业人士（全年参加一项运动，排除其他运动）中第二常见的单一运动活动，仅次于体操。平均症状持续时间为 4.0 个月。 尽管大多数患者 (83.5%) 的腰椎应力损伤仅为较低，但 9.1% 的损伤发生在 L3 水平或以上。超过一半的患者在 MRI 上有活动性单节段/椎弓根骨折，该亚组出现症状前的平均症状持续时间为 4.0 个月。即使将椎弓根应力反应排除在分析之外，仍有 7.1% 的患者受到 L3 水平或以上的损伤。 结论：在 8 至 21 岁的男性和女性运动员中，通过 MRI 评估出现症状性关节间肌和椎弓根应力损伤。在初次诊断时，上腰椎应力损伤的发生率比之前报道的要高。