MR imaging of lumbar spondylolysis: the importance of ancillary observations.

The purpose of this study was to determine the frequency of characteristic ancillary MR findings in patients with lumbar spondylolysis. The radiology reports and clinical records of 64 patients (16 female, 48 male; 12-77 years old) with 66 levels of lumbar spondylolysis who had undergone MR imaging were retrospectively reviewed. Spondylolysis was established by conventional radiography in all 64 patients and by CT in 18 patients. The proportion of patients with spondylolysis in whom sagittal MR images showed ancillary findings of an increased sagittal diameter of the spinal canal, reactive marrow changes in the pedicle, or abnormal wedging of the posterior aspect of the vertebral body was retrospectively determined. This proportion was then compared with the proportion of patients in whom spondylolysis was correctly diagnosed by the initial interpreters of the MR images, who used only direct visualization of defects of the pars interarticularis to make the diagnosis. Twenty (30%) of 66 levels of lumbar spondylolysis were misdiagnosed when the MR images were initially interpreted using direct visualization of defects of the pars interarticularis. An increased sagittal diameter of the spinal canal was the most common ancillary observation, occurring at 60 of 66 levels of lumbar spondylolysis. This finding was present in all patients with grade II, III, or IV spondylolisthesis, in 95% of patients with grade I spondylolisthesis; and in 77% of patients with no anterolisthesis. Thirty-two (48%) of 66 lumbar levels showed wedging of the posterior aspect of the vertebral body, which correlated significantly with the grade of spondylolisthesis. Reactive marrow changes in the pedicle distinct from normal adjacent levels were seen on MR images in 24(36%) of 66 levels of lumbar spondylolysis. On MR images, 97% of all levels of lumbar spondylolysis yielded one or more ancillary observations, including all 20 of the cases originally misdiagnosed. The combined use of ancillary observations and direct visualization of pars interarticularis defects makes MR imaging effective in revealing lumbar spondylolysis.