Zusammenfassung.
Ziel: Darstellung der Wertigkeit der MR-Tomographie in der Diagnostik der Spondylolyse im
Stadium der Entstehung. Methoden: 9 sportlich aktive jugendliche Patienten im Alter von 8 - 16 Jahren (∅12,5 Jahre)
mit Rückenschmerzen bei der Hyperextension wurden MR-tomographisch untersucht. In
6 Fällen lag eine CT, in 5 Fällen Röntgenaufnahmen vor. Ergebnisse: Bei den 9 Jugendlichen wurden Knochenmarködeme in der Pars interarticularis und den
Bogenwurzeln nachgewiesen, die in 4 Patienten beidseitig vorhanden waren. In 7/9 Fällen
war LWK 5 betroffen, in 2/9 LWK 4. In 3 Fällen reichte das Ödem in die Wirbelkörper,
bei 2 Patienten bestand Verdacht auf einen Tumor. Alle CT-Aufnahmen zeigten beidseits
inkomplette oder komplette Spaltbildungen der Pars interarticularis, in 4/6 Fällen
bestand eine Sklerose in dem Bereich, der MR-tomographisch ein Knochenmarködem aufwies.
Nur auf einer von fünf Röntgenaufnahmen bestand der Verdacht auf eine Spondylolyse.
Schlußfolgerung: Um auslösende Ursachen beseitigen und eine spezifische Therapie durchführen zu können,
ist die möglichst frühzeitige Diagnose einer drohenden Spondylolyse erforderlich.
Die MR-Tomographie sollte die erste und einzige Untersuchungsmethode sein, wenn jugendliche
Patienten nach Belastungen und bei Hyperextension über Rückenschmerzen klagen. Die
Skelettszintigraphie und die CT sollten wegen der Anwendung ionisierender Strahlung
vermieden werden, Röntgenübersichtsaufnahmen sind gewöhnlich ohne Befund, wenn eine
Spondylolyse im Stadium der Entwicklung vorliegt.
Purpose: To assess the value of MR imaging in demonstrating ongoing spondylolysis in adolescents.
Methods: MRI was performed in 9 juvenile patients (3 female, 6 male aged 8 - 16 years; mean
12.5 y) with pain during hyperextension. In 6 patients a CT scan and in 5 a plain
film was available. Results: In all patients bone marrow edema was found in the pars interarticularis and the
pedicle, which was bilateral in 4 patients. In 7/9 cases the L5 vertebra was affected,
in 2/9 cases spondylolysis was found in L4. In 3 cases the edema reached the middle
third of the vertebral body and a tumor was suspected. In all CT scans a bilateral
incomplete or complete cleft in the pars interarticularis was found. In 4/6 CT-scans
a sclerosis was seen in the area of the bone marrow edema. Only in 1/5 plain films
was there a suspicion for a spondylolysis, four examinations were completely normal.
Conclusions: To eliminate underlying causal conditions of spondylolysis and to install specific
therapy, early diagnosis is mandatory. MR imaging should be the first and only imaging
modality in young patients with low back pain during and after exercise and pain with
hyperextension. Bone scans and CT scans should be avoided due to irradiation, plain
films usually do not reveal pathological findings in developing sponylolysis.
Schlüsselwörter:
Spondylolyse - Magnet-Resonanz-Tomographie - Computertomographie
Key words:
Spondylolysis - magnetic resonance tomography - computed tomography
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Dr. PD A. Stäbler
Institut für Diagnostische Radiologie Klinikum der Ludwig-Maximilians-Universität
München, Großhadern
Marchioninistr. 15
81377 München
