The pars interarticularis can fracture, leading to spondylolisthesis. Pars interarticularis defect statpearls ncbi bookshelf. A fracture of the pars interarticularis may ultimately become unstable leading to spondylolisthesis. Pars defect is also known as par interarticularis defect or pars fracture of the lumbar spine. Pars interarticularis injury in elite athletes the role of imaging in. They also had a previous medical history of lumbar spine surgery. In patients with back pain and no clinical findings of nerve root involvement, computed tomography ct scanning of the lumbar spine yields information. Imaging techniques for the diagnosis of spondylolisthesis. Spondylolysis is a unilateral or bilateral defect of the pars interarticularis, an.
The use of magnetic resonance imaging in the evaluation of. Defects were bilateral but only one side is depicted. The authors describe the novel technique of minimally. If the test produces pain, this is indicative of active spondylolysis 4.
Spondylolysis refers to a defect in the pars interarticularis a bone connecting one facet joint to another. The value of spect in the detection of stress injury to. Pars fracture xray of a pars interarticularis fractur. Injury of the pars interarticularis is a common cause of low back pain, particularly in adolescent athletes.
Pars interarticularis refers to a small segment of bone that joins the facet joints in the back of the spine. We have documented this lesion in 14 adolescent athletes engaged in. The segment of bone between the superior and inferior articular facets, especially in the lumbar spine. This is the bony bridge between the superior and inferior articulating facets of the left pars of l3. At upper lumbar levels and in the incomplete fractures of the pars interarticularis with marked surrounding sclerosis, mri has apparent limitations compared to ct imaging. Prior to ct the current gold standard and mri, the imaging modality of choice was plain. Radiographs of the pars interarticularis were classified as type 0, normal. Acute pars interarticularis stress response radiology. Imaging assessment of pars interarticularis injury in. In addition, a detailed description of a physiotherapy program for this population.
As such, the diagnosis of a pars interarticularis defect confirmation is only with. Three stages of injury to the pars interarticularisthe portion of the lower spine that joins together the upper and lower jointsexist. Spondylolysis is frequently missed by mri in adolescents. Stress fracture of the pars interarticularis is an increasing cause of disability in highly competitive adolescent athletes. A, lateral plain film demonstrates a fracture of the pars interarticularis of l4 with a grade i spondylolisthesis of l4 on ls. In the evaluation of spondylolysis, plain radiographs are commonly used as the firstline imaging. Injury of the pars interarticularis is a common cause of low back pain, particularly in. Spondylolysis is a defect in the pars interarticularis of the neural arch, the portion of the neural arch that connects the superior and inferior articular facets. Magnetic resonance mr imaging should be used as the primary investigation for adolescents with back pain and suspected stress reactions of the lumbar pars interarticularis. The pars interarticularis is the segment of bone bounded by the lamina, pedicle, inferior. Avoid using the simple word pars in the special sense of pars interarticularis. In this instance, the medical provider recommended a computerized tomography ct scan that was part of a nuclear medicine image merge study in which the two imaging techniques, ct and nuclear medicine, were. Radiological findings and healing patterns of incomplete.
Pars interarticularis defects relate to spondylolysis andor spondylolisthesis of the spinal vertebra. S, sagittal mr image 30002s2 shows frac ture of pars white arrows, gap in defect, and stenosis of l4ls neural foramen. Activities involving repetitive hyperextension andor extension rotation of. The vast majority of cases occur in the lower lumbar vertebrae l5, but. Radiologic classification and indications for radionuclide imaging, author pennell, r and maurer, a r and bonakdarpour, a.
Recently, a person visited diagnostic imaging services due to experiencing low back and right leg pain. Micheli lj, curtis c 2006 stress fractures in the spine and sacrum. It is commonly known as pars interarticularis defect. The pars interarticularis, or pars for short, is the part of a vertebra located between the inferior and superior articular processes of the facet joint in the transverse plane, it lies between the lamina and. As such, the diagnosis of a pars interarticularis defect confirmation is only with radiographic support.
Lower back pain from spondylolysis historically has been treated with a variety of options ranging from conservative care to open fusion. Pars defect may be present since childhood without any. On oblique views, a lucency in the pars interarticularis representing a break in or collar on the scottie dogs neck indicates. Stress reactions involving the pars interarticularis in. A stress fracture to the pars interarticularis aka spondylolysis is a very common condition especially in adolescents and particularly in sports like cricket, gymnastics and rugby. In a radiographic study using computed tomography ct in 532 patients aged. Fracture of the pars interarticularis in adolescent. In early studies, magnetic resonance imaging mri had low sensitivity and positive predictive value in the evaluation of the pars interarticularis pathology. Many will return to sports long before imaging studies show resolution of the.
Imaging assessment of pars interarticularis injury in young athletes. This type of spinal fracture causes spondylolisthesis. Spondylolysis spondeelowlyesis is defined as a defect or stress fracture in the pars interarticularis of the vertebral arch. Ct findings in a patient with pars interarticularis fracture. Type iistress fracture or acute fracture in the pars interarticularis. Stress fractures of pars interarticularis in adolescent athletes a classification system with mri and ct enabling evaluation of the healing process sundell cg1, jonsson h2, adin l3 and larsen k1, 4. A pars stress fracture is the most common cause of lower back pain in. Rehabilitation guidelines for lumbar spondylolysis. Request pdf pars interarticularis injury in elite athletes the role of imaging in diagnosis and management injuries of the lumbar neural arch, in particular.
The incidence of pars interarticularis defects in athletes. The value of spect in the detection of stress injury to the pars. The neck of the scottie dog white arrows is intact. The definition of pars interarticularis defect is a unilateral or bilateral. Pdf imaging assessment of pars interarticularis injury. Minimally invasive imageguided direct repair of bilateral. This is a region of the lamina located between the facet joints. A pars stress fracture or early spondylolysis are common and a misdiagnosis is often made. A pars fracture occurs when the bony pars interarticularis breaks. Stress fracture of pars interarticularis lower back injuries. All of the patients were involved in sports at first onset of symptoms. The abnormality, discussed in detail in the section on isthmic spondylolisthesis, can be detected on lateral or coneddown lateral views fig.
The objective was to retrospectively record the ct and mri features and healing patterns of acute, incomplete stress fractures of the pars interarticularis. Meaning, the xray beam is tilted 20 degrees down from bac. Pars defect is a condition that affects the lumbar spine, causing low back pain. Spondylolysis, a defect in the pars interarticularis, is a common radiographic finding in spondylolisthesis. Patients with an actual fracture of the pars interarticularis have a discontinuity or fragmentation of the pars interarticularis that is seen best on sagittal short tr images. Lumbar spondylolysis, a unilateral or bilateral stress fracture of the narrow bridge between the upper and lower pars interarticularis, is a common cause of low back pain lbp in adolescent. Children with pars inter articularis stress fractures usually present with pain in the lower back which may be on. Diagnosis of spondylolysis making an early diagnosis with a pars defect is important to help assess early stage pars defects that that are.
Pars fractures and spondylolisthesis spineuniverse. Mri is not as sensitive as spect for identifying bone stress of the pars interarticularis and does not delineate bony detail to the same extent as ct 16, 25. This is the acute imaging appearance of stress response in the pars interarticularis without a definite established fracture. Mr imaging of the pars interarticularis 1215 mr imaging of the lumbar spine has become a useful method for the noninvasive evaluation of low back pain. What are the best core exercises for pars stress fracture. It is a spectrum of disease where repetitive bone stress and microtrauma create. Results in the literature support the use of bone scintigraphy to diagnose bone stress in. Stress fractures of pars interarticularis in adolescent. Pars defect is one of the common causes of back pain in adolescents. This educational article explains and illustrates the anatomy of the low back involved, and describes the causes, diagnosis and healing of these related. It particularly affects the area of a bone called pars interarticularis in the spinal vertebrae.
It is commonly known as pars interarticularis defect or more simply as pars defect. Whether a complete fracture has occurred can be difficult to assess on routine. Magnetic resonance imaging can provide more specific information regarding neurologic and soft tissue structures and is essential in evaluating the extent of cord injury, with or without. Plain radiography with posteroanterior p a, lateral and oblique views have proved very useful in the initial. A defect in this portion of the spine leads to a condition called spondylolysis. View media gallery patients with an actual fracture of the pars interarticularis have a discontinuity or fragmentation of the pars interarticularis that is seen best on sagittal short tr images. Type icongenital abnormalities due to attenuated pars.
1525 367 1553 843 1423 914 1595 1548 1180 488 1449 423 1615 667 583 237 1284 1333 526 798 771 387 859 36 89 300 1500 287 664 1081 791 277 202 884 481 1210 308 344 669 1359 506 220 250