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Detection of Pars Injury by SPECT in Patients Younger Than Age 10 With Low Back Pain

Spencer, Hillard T. MD*; Sokol, Levi O. MD; Glotzbecker, Michael P. MD*; Grant, Frederick D. MD; d’Hemecourt, Pierre A. MD§; Micheli, Lyle J. MD§; Treves, S. Ted MD

Journal of Pediatric Orthopaedics: June 2013 - Volume 33 - Issue 4 - p 383–388
doi: 10.1097/BPO.0b013e318285c3be
Spine Trauma

Background: Evaluation of extension-based low back pain in young athletes with suspected pars injury may include a referral for skeletal single photon emission computed tomography (SPECT). However, the diagnostic yield of this technique in children with low back pain before the age of 10 years remains uncertain. We examined a series of consecutive SPECT scans to address this question.

Materials and Methods: A retrospective review of department databases revealed 107 consecutive skeletal Tc-99m MDP SPECT scans performed between January 1, 2007 and December 31, 2009 in children less than 10 years of age. Of these, 72 studies were performed for a referral diagnosis of back pain. There were 43 girls (44 studies) and 28 boys (28 studies). The mean age was 7.2 years (range, 1.9 to 9.9 y). All SPECT scans were reviewed and positive findings documented. In addition, all available anatomic imaging, imaging reports (computed tomography, magnetic resonance, and x-ray) and clinical notes were reviewed, and results were compared with those of SPECT studies.

Results: Of the 72 SPECT studies, 35 (49%) identified a focal area in the spine of abnormal increased uptake, with 17 in the region of the pars interarticularis. With additional imaging, 1 case was demonstrated not to be a pars injury (computed tomography showed a transverse process fracture) and 2 patients with negative SPECT scans were shown to have pars injuries that SPECT scan had not detected, for a total of 18 pars injuries (25%) in this cohort. Reported participation in gymnastics or football was related to pars injury (odds ratio 4.3, P=0.04).

Conclusions: Pars injury was found in 25% of children referred for SPECT scan with back pain below 10 years of age. SPECT scan was highly sensitive for this injury as well as in identifying other potential sites of pathology, and should be considered in the workup of persistent low back pain in young children.

Level of Evidence: Level II, diagnostic study.

Division of Nuclear Medicine and Molecular Imaging, Department of Radiology

§Division of Sports Medicine, Department of Orthopedic Surgery

*Department of Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA

Nuclear Medicine, Diagnostic Radiology, New York, NY

The authors declare no conflict of interest.

Reprints: Hillard T. Spencer, MD, Department of Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115. E-mail:;

© 2013 by Lippincott Williams & Wilkins