Facture of the Pars Interarticularis with or without Spondylolisthesis in an Adult Population in a Developing Country: Evaluation by Multidetector Computed Tomography

Abstract

Study design: Descriptive cross-sectional study.

Purpose: To determine the prevalence of lumbar spondylolysis and spondylolisthesis in a general adult population unrelated to lower back pain as evaluated by multidetector computed tomography.

Overview of literature: There is a significant paucity of information related to the prevalence of spondylolysis and spondylolisthesis and its degenerative changes in a general adult population unrelated to lower back pain in developing countries.

Methods: A retrospective study was conducted on abdominopelvic computed tomography (CT) scans performed between January 1st 2015 and December 31st 2015 for various clinical indications. Patients with lower back pain, with a history of trauma or road traffic accident, or referred from orthopedic or neurosurgery departments were excluded to avoid any bias. CT scans were reviewed in axial, sagittal, and coronal planes using bone window settings for evaluating spondylolysis and spondylolisthesis.

Results: Of 4,348 patients recruited, spondylolysis and spondylolisthesis were identified in 266 (6.1%) and 142 (3.3%) patients, respectively. Age was significantly higher in both spondylolysis and spondylolisthesis patients than in those without spondylolysis and spondylolisthesis (47.19±15.45 vs. 42.5±15.96, p<0.001 and 53.01±15.31 vs. 42.44±15.88, p<0.001, respectively). Gender was significantly associated with spondylolisthesis (p=0.029) but not spondylolysis. Of patients who were >60 years old, both spondylolysis (p=0.018) and spondylolisthesis (p=0.025) were significantly more prevalent in females.

Conclusions: The prevalence of pars interarticularis fracture observed higher with gradual increase in the prevalence with advancing age. In particular, preponderance was significantly higher among older females.

Keywords: Lumbarsacral spondylosis; Spine; Spondylolisthesis.

Fig. 1. Computed tomography scan bone window image of a 19-year-old male presenting with abdominal pain. (A) Axial sections showing a bilateral break in the pars interarticularis (arrows). (B) Sagittal reconstructed image of the same patient showing a break of the pars interarticularis at the L5 level (arrow).

Fig. 2. Computed tomography scan bone window of a 38-year-old male presenting with severe pain in the epigastric region. (A) Axial images showing a bilateral pars interarticularis fracture (arrows). (B) Sagittal reconstruction of the same patient showing a fracture of the pars interarticularis involving L5 with grade II spondylolisthesis (arrow). Mild degenerative changes were also seen with vacuum phenomena at the L5/S1 level.