An athlete with low back pain should be evaluated for a stress fracture of the pars interarticularis with spondylolysis. This is particularly important to detect in adolescents.
Athletes at increased risk:
(1) gymnasts
(2) football linemen
(3) ballet
(4) volleyball
(5) diving
(6) cricket
(7) soccer
(8) ice hockey
(9) lacrosse
Common risk factor: rotational forces around the spine with load-bearing hyperextension
Evaluation of the lumbar spine:
(1) bone scintigraphy with SPECT
(2) lumbar CT if scintigraphy positive
Bone Scintigraphy with SPECT
Lumbar CT
Interpretation
negative
NA
negative
positive
negative
active spondylolysis with stress reaction
positive
positive
active spondylolysis with stress fracture
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