technetium-tc-99m-medronate and Spondylolysis

The purpose of this study was to evaluate the usefulness of 99mTc-MDP SPECT (bone SPECT) for lumbar spondylolysis. We analyzed 11 cases with 17 lesions. All cases were compared using plain radiography, computed tomography (CT), planar bone scintigraphy (PBS), and bone SPECT. Four lesions that showed a wide defect on CT were negative on bone SPECT and may have been chronic lesions. Thirteen lesions that were positive on bone SPECT were narrow or showed no defect on CT and may have been early lesions. Two cases showed no defect on CT but were positive on bone SPECT, and one of them progressed to bilateral spondylolysis after one year. This may have been a very early lesion. Thus bone SPECT is useful for the diagnosis of lumbar spondylolysis, especially in its early stage.

Topics: Adolescent; Evaluation Studies as Topic; Female; Humans; Lumbar Vertebrae; Male; Radiopharmaceuticals; Spondylolysis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Single photon emission computed tomography (SPECT) bone scans of the lumbar spine were evaluated in the management of patients with low back pain and suspected spondylolysis.. Thirty-three patients (mean age, 30 years) with high clinical suspicion of pars interarticularis defects were included in the study. The results of lumbar radiographs and SPECT bone scintigraphy were compared and the influence of these results on patient management was evaluated.. Twenty-six of the 33 patients had abnormal results of lumbar radiographs. Of the 21 patients with radiographs indicating spondylolysis, six had abnormal uptake in the pars regions on bone scintigraphy. One patient with normal results of lumbar radiographs had a SPECT bone scan showing uptake in the region of the pars interarticularis.. SPECT bone scanning of the lumbar spine has a role in the treatment of patients with symptomatic spondylolysis.

Topics: Adult; Female; Humans; Low Back Pain; Lumbar Vertebrae; Male; Radiography; Radiopharmaceuticals; Spondylolysis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Adolescent; Humans; Lumbar Vertebrae; Male; Radiopharmaceuticals; Sacroiliac Joint; Spondylolysis; Technetium Tc 99m Medronate; Tomography, Emission-Computed

The aim of this study was to clarify the clinical role of bone single photon emission tomography (SPET) of the lumbar spine in young persons with persistent lumbar pain which might be due to spondylolysis. Thirty-one bone SPET studies were performed on 25 patients (19 males, 6 females) aged 7-26 years (average 15.6 years) who had suffered lumbar pain associated with physical activity, and who were suspected of having spondylolysis. Planar and SPET images of the lumbar spine were obtained 2-3 h following the injection of 99Tc(m)-methylene diphosphonate using a single-head rotating gamma camera. The findings on the bone scintigram were compared with those on the radiograph. Bone scintigraphy at presentation was positive in only 7 of 15 sites of the pars interarticularis defects demonstrated on plain radiographs. On the other hand, seven sites of the pars interarticularis which were normal on the radiograph were positive on bone SPET. As clinical symptoms improved after immobilization using a lumbar corset, bone SPET tended to revert towards normal. The planar image was abnormal in only 8 (42%) of the 19 abnormal sites on the SPET image. A bone SPET study is indicated in patients who are negative on radiological tests and who are still suspected of having spondylolysis. If SPET is positive in these patients, the increased bone uptake is most likely suggestive of a state of 'stress reaction', and may be a good indicator for patient management. If negative, further radiological examinations will be required for proper assessment of the origin of lumbar pain.

Topics: Adolescent; Adult; Child; Female; Gamma Cameras; Humans; Lumbar Vertebrae; Male; Pain; Radiography; Spondylolysis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Three patients with unilateral spondylolysis were evaluated with SPECT and Lumbar CT. All three cases had positive scans. However, the SPECT images were unique to each case. Therefore, the interpretation of the SPECT activity was undertaken in terms of the known natural history of both unilateral and bilateral spondylolysis.

Topics: Adolescent; Adult; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Spondylolysis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Fifty patients with back pain and radiologically diagnosed spondylolysis were evaluated by a single-photon emission computed tomography (SPECT bone scanning). These patients were separated into three groups according to the degree of spondylolisthesis accompanying the spondylolysis. The data obtained from the study indicate that in acute spondylolysis, the SPECT scan is positive at the pars interarticularis. As the spondylolysis becomes chronic, the SPECT scan tends to revert toward normal even though healing of the spondylolysis has not occurred. As spondylolisthesis develops and progresses, the SPECT scan again becomes positive. The positivity, however, is more anterior and more diffuse. The authors propose that SPECT scanning in spondylolysis is not a positive or negative process, but rather varies with the time and stability of the spondylolytic spine.

Topics: Adolescent; Adult; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Spondylolisthesis; Spondylolysis; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed, Single-Photon

Topics: Adolescent; Diagnosis, Differential; Humans; Lumbar Vertebrae; Male; Osteoma, Osteoid; Radionuclide Imaging; Spinal Neoplasms; Spondylolysis; Technetium Tc 99m Medronate

Thirty-three patients attending the Nottingham Sports Injury Clinic in whom a clinical diagnosis of a stress fracture of the pars interarticularis was made were evaluated with both radiography and bone scintigraphy. This was done in an effort to distinguish a recent stress fracture which would produce a positive scintigram from an established 'incidental' spondylolysis giving a normal scintigram. Nine patients demonstrated abnormal radiography with a normal scintigram. A further nine patients had a positive scintigram. Six were associated with a spondylolysis indicating a recent stress fracture but two had normal radiography suggesting a stress fracture in the 'sub-radiological' phase. One patient had increased uptake in relation to degenerative changes of the lower lumbar facet joints. Oblique views of the scintigram helped in localisation of the abnormal uptake to the pars interarticularis.

Topics: Adolescent; Adult; Athletic Injuries; Cumulative Trauma Disorders; Football; Fractures, Bone; Humans; Lumbar Vertebrae; Radiography; Radionuclide Imaging; Skiing; Spondylolisthesis; Spondylolysis; Technetium Tc 99m Medronate

In 66 patients with back pain and suspected spondylolysis, the results of bone scintigraphy have been correlated with operative findings and clinical follow-up. Although bone scintigraphy is of little value for primary diagnosis, it helps to distinguish between those patients with established non-union of the defect, and those in whom healing is still progressing and who may benefit from immobilisation. We also found that increased uptake on the contralateral side to a unilateral spondylolysis is suggestive of impending fracture.

Topics: Adolescent; Adult; Back Pain; Child; Female; Humans; Lumbar Vertebrae; Male; Radiography; Radionuclide Imaging; Spondylolisthesis; Spondylolysis; Technetium Tc 99m Medronate

This study looks retrospectively at 113 patients with low back pain referred by orthopaedic surgeons for bone scanning. 79 scans (70%) were reported normal and 34 scans (30%) abnormal. 61 out of the 79 patients with normal scans were diagnosed and managed as "chronic back strain". Negative bone scans were also encountered in 3 patients with degenerative disease, 3 with prolapsed intervertebral disc and one with spondylolysis. In those patients with positive scans, a varied range of diagnoses was encountered, the main ones being bone metastases, previous trauma, osteomyelitis and degenerative disease. The scan was shown to be helpful in deciding on the presence or absence of pathology, and in identifying the sites of involvement, but not the nature of the disease. A higher likelihood of positivity is seen in the more elderly patients as well as those below 20 years of age. In interpreting the scan, the clinical context is important e.g. a history of trauma, previous surgery or of malignant disease. The bone scan may be normal in disc prolapse and in degenerative disease of the spine.

Topics: Adolescent; Adult; Aged; Back Pain; Child; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Radionuclide Imaging; Spinal Diseases; Spondylolysis; Technetium Tc 99m Medronate

Presenting radiographs of 30 children with spondylolisthesis and spondylolysis were reviewed. A 67% incidence of spina bifida occulta was noted, a 13-fold increase of the incidence in the normal population, and a mechanism whereby this may precipitate a spondylolysis is given. The value of the spinous process rotation sign on AP radiographs and facet joint mal-alignment on oblique radiographs in paediatric practice was assessed, and the incidence was 39% and 56% respectively, compared with 92% and 91% in adult practice. Reasons for the reduced incidence are suggested. Oblique radiographs provided further diagnostic information only in the absence of a spondylolisthesis. Follow-up radiographs showed further slip in only five patients. The one constant factor in these five patients was the presence of a spina bifida occulta, indicating the necessity for close observation of such patients with a spondylolisthesis during the adolescent growth spurt. 99Tcm MDP bone scans were performed in three patients, in whom 4 of 5 spondylolyses were shown to have a high uptake. One lesion subsequently became of low uptake as symptoms subsided. Bone scanning in spondylolisthesis needs further evaluation but the finding of increased bone activity suggests a healing process. Spondylolysis is a differential diagnosis to be considered in a positive scan for evaluation of back pain.

Topics: Adolescent; Child; Child, Preschool; Diphosphonates; Female; Follow-Up Studies; Humans; Lumbar Vertebrae; Male; Posture; Radiography; Radionuclide Imaging; Sacrum; Spina Bifida Occulta; Spondylolisthesis; Spondylolysis; Technetium; Technetium Tc 99m Medronate