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Case Reports
. 2018 Feb 15;58(2):91-95.
doi: 10.2176/nmc.cr.2017-0123. Epub 2017 Dec 25.

Utility of STIR-MRI in Detecting the Pain Generator in Asymmetric Bilateral Pars Fracture: A Report of 5 Cases

Kazuta Yamashita  1 , Toshinori Sakai  1 , Yoichiro Takata  1 , Fumio Hayashi  1 , Fumitake Tezuka  1 , Masatoshi Morimoto  1 , Yutaka Kinoshita  1 , Akihiro Nagamachi  1 , Takashi Chikawa  1 , Hiroshi Yonezu  1 , Kosaku Higashino  1 , Tadanori Sakamaki  1 , Koichi Sairyo  1
Affiliations
Case Reports

Utility of STIR-MRI in Detecting the Pain Generator in Asymmetric Bilateral Pars Fracture: A Report of 5 Cases

Kazuta Yamashita et al. Neurol Med Chir (Tokyo). .

Abstract

Lumbar spondylolysis usually occurs as a stress fracture in the pars interarticularis of the vertebra. It is a prevalent sports-related disorder and a common cause of low back pain. We encountered five athletes (4 males, 1 female) with severe low back pain. Mean age was 14.5 years. All five patients were found to have bilateral pars fracture. In all cases, staging based on the findings from computed tomography scan of the right and left pars fracture was different. On short tau inversion recovery magnetic resonance imaging (STIR-MRI) of the comparatively newer more recently injured side, high signal intensity changes were obvious and dominant at the intra- and extraosseous area, which would indicate tissue edema and/or bleeding. Furthermore, the imaging findings corresponded to the side of the low back pain. In conclusion, STIR-MRI can effectively distinguish between painful pars fracture and painless pars fracture.

Keywords: STIR-MRI; bleeding; edema; pars fracture; spondylolysis.

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Conflict of interest statement

Conflicts of Interest Disclosure

One of the authors, Koichi Sairyo has conflict of interest (Japan MDM, Senko Medical, Surgical Spine). However, these companies are not concerned with the content of this manuscript. Other authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

Fig. 1.
Fig. 1.
Case 1: 17-year-old male basketball player. Axial view of CT and STIR-MRI. Circle shows bone marrow edema, arrows show extraosseous edema and bleeding around right pars fracture.
Fig. 2.
Fig. 2.
Case 2: 9-year-old male baseball player. Axial view of CT and STIR-MRI. Circle shows bone marrow edema, arrows show extraosseous edema and bleeding around right pars fracture.
Fig. 3.
Fig. 3.
Case 3: 20-year-old male hurdler (track and field). Axial view of CT and STIR-MRI. Circle shows bone marrow edema, arrows show extraosseous edema and bleeding around right pars fracture.
Fig. 4.
Fig. 4.
Case 4: 17-year-old male soccer player. Axial view of CT and STIR-MRI. Circle shows bone marrow edema, arrows show extraosseous edema and bleeding around right pars fracture.
Fig. 5.
Fig. 5.
Case 5: 11-year-old female volleyball player. Axial view of CT and STIR-MRI. Circle shows bone marrow edema, arrows show extraosseous edema and bleeding around right pars fracture.
See this image and copyright information in PMC

References

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