Yokoe Takuji, Tajima Takuya, Sugimura Hiroshi, Kubo Shinichirou, Nozaki Shotarou, Yamaguchi Nami, Morita Yudai, Chosa Etsuo
Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan.
Department of Radiology, Nozaki Higashi Hospital, Murasumi, Miyazaki, Japan.
Orthop J Sports Med. 2021 Apr 9;9(4):2325967121995466. doi: 10.1177/2325967121995466. eCollection 2021 Apr.
Spondylolysis and undiagnosed mechanical low back pain (UMLBP) are the main causes of low back pain (LBP) in adolescent athletes. No studies have evaluated the difference in clinical and radiographic factors between these 2 conditions. Furthermore, it remains unclear which adolescent athletes with LBP should undergo advanced imaging examination for spondylolysis.
To compare the clinical and radiographic factors of adolescent athletes with spondylolysis and UMLBP who did not have neurological symptoms or findings before magnetic resonance imaging (MRI) evaluation and to determine the predictors of spondylolysis findings on MRI.
Cohort study, Level of evidence, 3.
The study population included 122 adolescent athletes aged 11 to 18 years who had LBP without neurological symptoms or findings and who underwent MRI. Of these participants, 75 were ultimately diagnosed with spondylolysis, and 47 were diagnosed with UMLBP. Clinical factors and the following radiographic parameters were compared between the 2 groups: spina bifida occulta, lumbar lordosis (LL) angle, and the ratio of the interfacet distance of L1 to that of L5 (L1:L5 ratio, %). A logistic regression analysis was performed to evaluate independent predictors of spondylolysis on MRI scans.
Significantly more athletes with spondylolysis were male (82.7% vs 48.9%; < .001), had a greater LL angle (22.8° ± 8.1° vs 19.3° ± 8.5°; = .02), and had a higher L1:L5 ratio (67.4% ± 6.3% vs 63.4% ± 6.6%; = .001) versus athletes with UMLBP. A multivariate analysis revealed that male sex (odds ratio [OR], 4.66; < .001) and an L1:L5 ratio of >65% (OR, 3.48; = .003) were independent predictors of positive findings of spondylolysis on MRI scans.
The study findings indicated that sex and the L1:L5 ratio are important indicators for whether to perform MRI as an advanced imaging examination for adolescent athletes with LBP who have no neurological symptoms and findings.
椎弓根峡部裂和未确诊的机械性下腰痛（UMLBP）是青少年运动员下腰痛（LBP）的主要原因。尚无研究评估这两种情况在临床和影像学因素上的差异。此外，对于哪些患有LBP的青少年运动员应接受针对椎弓根峡部裂的高级影像学检查仍不清楚。
比较在磁共振成像（MRI）评估前无神经症状或体征的患有椎弓根峡部裂和UMLBP的青少年运动员的临床和影像学因素，并确定MRI上椎弓根峡部裂表现的预测因素。
队列研究，证据级别：3级。
研究人群包括122名年龄在11至18岁之间、患有LBP且无神经症状或体征并接受了MRI检查的青少年运动员。在这些参与者中，75人最终被诊断为椎弓根峡部裂，47人被诊断为UMLBP。比较了两组之间的临床因素以及以下影像学参数：隐性脊柱裂、腰椎前凸（LL）角以及L1与L5椎间距离之比（L1:L5比率，%）。进行了逻辑回归分析以评估MRI扫描上椎弓根峡部裂的独立预测因素。
与患有UMLBP的运动员相比，患有椎弓根峡部裂的运动员中男性明显更多（82.7%对48.9%；P <.001），LL角更大（22.8°±8.1°对19.3°±8.5°；P =.02），L1:L5比率更高（67.4%±6.3%对63.4%±6.6%；P =.001）。多变量分析显示，男性（比值比[OR]，4.66；P <.001）和L1:L5比率>65%（OR，3.48；P =.003）是MRI扫描上椎弓根峡部裂阳性表现的独立预测因素。
研究结果表明，性别和L1:L5比率是对于没有神经症状和体征的患有LBP的青少年运动员是否进行MRI作为高级影像学检查的重要指标。
