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Chiropractic Research Review

Classifying Spondylolysis with MRI Reliable

Lumbar spondylolysis, reported in up to 47% of adolescent athletes, occurs when defects or fractures develop in the pars interarticularis because of stress from sports such as weightlifting, gymnastics, baseball, and rowing.

Spondylolysis generates observable symptoms in only some individuals, and the level of fracture needed to produce low back pain (LBP) is unknown. High-field-strength magnetic resonance imaging (MRI) is sensitive in identifying stress injuries of the pars interarticularis; a reliable classification system is necessary for research to assess the relationship between MRI scans and prognosis.

The objective of this study was to evaluate the reliability of patient assignment into five grades of bone stress reaction in the pars interarticularis using 55 young athletes with LBP. Subjects underwent high-field-strength MRI in two sagittal sequences and one axial sequence; images were reviewed by three radiologists and classified under a new system developed specifically for spondylolysis. Of the patients evaluated, 42% showed positive findings on MRI. Intraobserver reliability was calculated for one of the radiologists initially and four weeks later, while interobserver reliability was measured between the three readers. Both interobserver and intraobserver reliability were high, ranging from 0.7 - 1.0.

Conclusion: MRI scans of stress reactions and/or spondylolysis in the lumbar pars interarticularis of young athletes may be reliably classified into five separate grades by experienced radiologists. This classifying system can be used as a tool to assess the efficacy of MRI in patients with abnormalities in the pars interarticularis. "The ability to identify a stress reaction early in its course allows for earlier appropriate intervention... treatment of an early stress injury is more likely to be successful than treatment of a complete spondylolysis," the authors conclude.

Hollenberg GM, Beattie PF, Meyers SP, et al. Stress reactions of the lumbar pars interarticularis: The development of a new MRI classification system. Spine 2002:27(2), pp. 181-186.

Chiropractic Research Review

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