Spondylolysis Part II: Imaging and Radiation Safety

I’ve wanted to return to the issue I wrote about in a blog post a week ago, “Spondylolysis:  Issues of Incidence and Imaging, Part I.”   In that post and this one, I have been primarily looking at a provocative new study published in the Journal of Pediatric Orthopaedics, “Imaging Modalities for Low Back Pain in Children:  a Review of Spondylolysis and Undiagnosed Mechanical Back pain.”

spectSingle Photon Emission Computerized Tomography, or SPECT scans, like the image to the left showing bilateral L5 spondylolyses, are highly sensitive for detecting spondylolysis but expose the patient to radiation.  This is something I have known, of course, since training.  In my current practice at Nationwide Children’s Hospital Division of Sports Medicine I and my group of fellow clinicians focus on youth athletes, and so we see large numbers of potential ‘spondys’ and, correspondingly, order a large number of diagnostic images.  In 2012 we saw 548 new patients whose chief complaint was back pain; we ordered 227 SPECT images for ‘back pain’  in that same year.

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