Ledonio Charles G T, Burton Douglas C, Crawford Charles H, Bess Robert Shay, Buchowski Jacob M, Hu Serena S, Lonner Baron S H, Polly David W, Smith Justin S, Sanders James O
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA.
Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3017, Kansas City, KS 66160, USA.
Spine Deform. 2017 Mar;5(2):97-101. doi: 10.1016/j.jspd.2016.10.006.
Spondylolysis is common among the pediatric population, yet no formal systematic literature review regarding diagnostic imaging has been performed. The Scoliosis Research Society (SRS) requested an assessment of the current state of peer reviewed evidence regarding pediatric spondylolysis.
Literature was searched professionally and citations retrieved. Abstracts were reviewed and analyzed by the SRS Evidence-Based Medicine Committee. Level I studies were considered to provide Good Evidence for the clinical question. Level II or III studies were considered Fair Evidence. Level IV studies were considered Poor Evidence. From 947 abstracts, 383 full texts reviewed. Best available evidence for the questions of diagnostic methods was provided by 27 studies: no Level I sensitivity/specificity studies, five Level II and two Level III evidence, and 19 Level IV evidence.
Pain with hyperextension in athletes is the most widely reported finding in history and physical examination. Plain radiography is considered a first-line diagnostic test for suspected spondylolysis, but validation evidence is lacking. There is consistent Level II and III evidence that pars defects are detected by advanced imaging in 32% to 44% of adolescents with spondylolysis based on history and physical. Level III evidence that single-photon emission computed tomography (SPECT) is superior to planar bone scan and plain radiographs but limited by high rates of false-positive and false-negative results and by high radiation dose. Computed tomography (CT) is considered the gold standard and most accurate modality for detecting the bony defect and assessment of osseous healing but exposes the pediatric patient to ionizing radiation. Magnetic resonance imaging (MRI) is reported to be as accurate as CT and useful in detecting early stress reactions of the pars without a fracture.
Plain radiographs are widely used as screening tools for pediatric spondylolysis. CT scan is considered the gold standard but exposes the patient to a significant amount of ionizing radiation. Evidence is fair and promising that MRI is comparable to CT.
脊椎峡部裂在儿童群体中很常见，但尚未进行关于诊断成像的正式系统文献综述。脊柱侧弯研究学会（SRS）要求对有关儿童脊椎峡部裂的同行评审证据的现状进行评估。
专业检索文献并获取参考文献。SRS循证医学委员会对摘要进行了审查和分析。I级研究被认为可为临床问题提供良好证据。II级或III级研究被认为是中等证据。IV级研究被认为是低质量证据。从947篇摘要中，审查了383篇全文。27项研究提供了关于诊断方法问题的最佳现有证据：没有I级敏感性/特异性研究，5项II级和2项III级证据，以及19项IV级证据。
运动员过度伸展时疼痛是病史和体格检查中报告最广泛的发现。X线平片被认为是疑似脊椎峡部裂的一线诊断测试，但缺乏验证证据。有一致的II级和III级证据表明，根据病史和体格检查，32%至44%的患有脊椎峡部裂的青少年通过先进成像检测到椎弓根缺损。III级证据表明，单光子发射计算机断层扫描（SPECT）优于平面骨扫描和X线平片，但受假阳性和假阴性结果的高发生率以及高辐射剂量的限制。计算机断层扫描（CT）被认为是检测骨缺损和评估骨愈合的金标准和最准确的方式，但会使儿科患者暴露于电离辐射。据报道，磁共振成像（MRI）与CT一样准确，并且在检测无骨折的椎弓根早期应力反应方面很有用。
X线平片被广泛用作儿童脊椎峡部裂的筛查工具。CT扫描被认为是金标准，但会使患者暴露于大量电离辐射。有中等且有前景的证据表明MRI与CT相当。
