MRI can evaluate radiculopathy elicited by both spondylolytic and nonspondylolytic causes and may demonstrate additional etiologies, including apophyseal fractures, intraspinous ligamentous injury, discogenic injury, Scheuermann disease, and compartment syndromes [8,31,40]. If contrast is administered, precontrast images are needed to assess enhancement. MRI of the spine in the clinical setting of back pain should always be performed with fat-saturated imaging techniques. There is little use for performing an MRI with contrast only. Contrast is not indicated in the evaluation of chronic back pain due to suspected mechanical causes. CT Spine CT is mostly considered an adjunct to other imaging modalities and has a high sensitivity in evaluation of spondylolysis [6]. CT is superior to radiographs in evaluation of spondylolysis, and with radiation dose-reduction techniques, a similar dose can be achieved [41]. CT has been shown to be complementary in the evaluation of pars interarticularis injuries and has the potential to direct further management [30]. Early stress reaction may be missed using CT alone without a bone scan or MRI [23,42]. Ring apophyseal injuries are also well demonstrated on CT [15,31]. CT spine with contrast is not indicated in mechanical back pain. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine There have been studies that have shown that bone scan with SPECT is a sensitive imaging technique for the evaluation of suspected spondylolysis at all ages [6,43,44]. Bone scan has been shown to be more sensitive in comparison to MRI for evaluation of active spondylolysis [19]. However, MRI may be able to detect disc pathology and other processes that can mimic or be associated with spondylolysis [32,40]. In chronic spondylolysis with wide separation and smooth margins, the bone scan may be negative [30]. On the other hand, bone scan can demonstrate increased uptake due to a stress reaction while CT reveals no abnormality [42].
Back Pain Child PCAs. MRI can evaluate radiculopathy elicited by both spondylolytic and nonspondylolytic causes and may demonstrate additional etiologies, including apophyseal fractures, intraspinous ligamentous injury, discogenic injury, Scheuermann disease, and compartment syndromes [8,31,40]. If contrast is administered, precontrast images are needed to assess enhancement. MRI of the spine in the clinical setting of back pain should always be performed with fat-saturated imaging techniques. There is little use for performing an MRI with contrast only. Contrast is not indicated in the evaluation of chronic back pain due to suspected mechanical causes. CT Spine CT is mostly considered an adjunct to other imaging modalities and has a high sensitivity in evaluation of spondylolysis [6]. CT is superior to radiographs in evaluation of spondylolysis, and with radiation dose-reduction techniques, a similar dose can be achieved [41]. CT has been shown to be complementary in the evaluation of pars interarticularis injuries and has the potential to direct further management [30]. Early stress reaction may be missed using CT alone without a bone scan or MRI [23,42]. Ring apophyseal injuries are also well demonstrated on CT [15,31]. CT spine with contrast is not indicated in mechanical back pain. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine There have been studies that have shown that bone scan with SPECT is a sensitive imaging technique for the evaluation of suspected spondylolysis at all ages [6,43,44]. Bone scan has been shown to be more sensitive in comparison to MRI for evaluation of active spondylolysis [19]. However, MRI may be able to detect disc pathology and other processes that can mimic or be associated with spondylolysis [32,40]. In chronic spondylolysis with wide separation and smooth margins, the bone scan may be negative [30]. On the other hand, bone scan can demonstrate increased uptake due to a stress reaction while CT reveals no abnormality [42].