Takemitsu Masakazu, El Rassi Georges, Woratanarat Patarawan, Shah Suken A
Department of Orthopaedics, Nemours Children's Clinic-Wilmington, Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA.
Spine (Phila Pa 1976). 2006 Apr 15;31(8):909-14. doi: 10.1097/01.brs.0000209308.19642.96.
Retrospective clinical study with radiographic and medical chart review.
To study the clinical characteristics and outcome of pediatric athletes with low back pain and unilateral tracer uptake on single photon emission computed tomography (SPECT) at the pars interarticularis but no defect on radiographs.
Some pediatric athletes with low back pain have no findings on plain radiographs but a unilateral SPECT uptake at the pars interarticularis. However, little is known about these patients.
Twenty-two pediatric athletes who had low back pain with increased tracer uptake on SPECT unilaterally at the pars interarticularis but no defect on plain radiograph were evaluated. The following criteria were used for evaluation: age, male-to-female ratio, duration of symptoms, vertebral level, and presence of spina bifida occulta or scoliosis.
The average age was 12.3 +/- 2.5 years. The male-to-female ratio was 1.2:1. The average duration of symptoms was 21 +/- 23 weeks. Nineteen (86%) had increased uptake at L5. Six (27%) had spina bifida occulta and 8 (36%) had scoliosis. Eighteen (82%) patients showed an excellent outcome. The patients who presented with a longer history of symptoms or a concomitant spina bifida occulta had an increased risk of having occasional aching with vigorous activity when compared with the patients who did not (P < 0.05).
Athletes who have low back pain and increased tracer uptake unilaterally at the pars interarticularis on SPECT are younger than those previously reported patients with spondylolysis proven by a defect on radiographs. Some of these lesions do progress to "frank" spondylolysis seen on radiographs, but favorable clinical outcomes from nonoperative treatment can be expected. Patients with a longer pain history or concomitant spina bifida occulta may need careful follow-up because they are at increased risk of having occasional low back pain.
一项通过影像学和病历回顾进行的回顾性临床研究。
研究患有腰痛且单光子发射计算机断层扫描（SPECT）显示关节突间部单侧放射性摄取增加但X线片无缺损的儿科运动员的临床特征及预后。
一些患有腰痛的儿科运动员X线平片未见异常，但SPECT显示关节突间部单侧放射性摄取增加。然而，对这些患者了解甚少。
对22例患有腰痛且SPECT显示关节突间部单侧放射性摄取增加但X线平片无缺损的儿科运动员进行评估。采用以下标准进行评估：年龄、男女比例、症状持续时间、椎体节段以及隐性脊柱裂或脊柱侧弯的存在情况。
平均年龄为12.3±2.5岁。男女比例为1.2∶1。平均症状持续时间为21±23周。19例（86%）在L5节段放射性摄取增加。6例（27%）有隐性脊柱裂，8例（36%）有脊柱侧弯。18例（82%）患者预后良好。与无症状的患者相比，症状持续时间较长或伴有隐性脊柱裂的患者在剧烈活动时偶尔出现疼痛的风险增加（P<0.05）。
患有腰痛且SPECT显示关节突间部单侧放射性摄取增加的运动员比先前报道的经X线片缺损证实为椎弓根峡部裂的患者更年轻。其中一些病变确实会发展为X线片上可见的“明显”椎弓根峡部裂，但非手术治疗可预期获得良好的临床预后。疼痛病史较长或伴有隐性脊柱裂的患者可能需要密切随访，因为他们偶尔出现腰痛的风险增加。
