Neural Arch Bone Marrow Edema and Spondylolysis in Adolescent Cheerleaders: A Case Series - PubMed (original) (raw)

Case Reports

Neural Arch Bone Marrow Edema and Spondylolysis in Adolescent Cheerleaders: A Case Series

Ashley N Ruff et al. J Chiropr Med. 2019 Dec.

Abstract

Objective: Spondylolysis is 1 of the most common sources of low back pain in children and adolescents; however, there is still a great deal of confusion in regard to etiology, clinical presentation, and diagnostic imaging findings. It is imperative for clinicians to recognize that persistent low back pain is strongly indicative of spondylolysis, especially in high-performance athletes. This case series demonstrates a comprehensive diagnostic spectrum of spondylolysis and its treatment in 2 competitive adolescent cheerleaders.

Clinical features: In case 1, a 12-year-old female competitive cheerleader presented with a gradual onset of subacute low back pain. Comprehensive clinical examination indicated imaging studies that identified bilateral L5 grade 1 stress reaction, consisting of neural arch bone marrow edema (BME). Treatment included spinal adjustments, rehabilitation, and myofascial therapy. In case 2, 15-year-old female competitive cheerleader presented with insidious chronic low back pain that was provocative with extension. Magnetic resonance imaging revealed a left L5 grade 1 pars interarticularis stress reaction. Computed tomography demonstrated right L5 pars grade 3 and left L5 healing spondylolysis. Treatment included spinal adjustments and rehabilitation exercises. She was also seen by a physical therapist who prescribed a lumbar spine flexion brace.

Intervention and outcome: Diagnosis of BME and spondylolysis led to temporary cessation of cheerleading activities in cases 1 and 2. The individual in case 1 self-discharged with a list of rehabilitation exercises and was lost to follow-up. The individual in case 2 was able to return to sport pain free approximately 5 weeks after seeking treatment.

Conclusion: Spondylolysis is common in adolescent athletes, and the presence of BME precedes spondylolysis. Primary spine providers could consider this diagnosis in any adolescent, especially an athlete, who has persistent low back pain. Timely diagnosis will optimize treatment outcomes.

Keywords: Adolescent; Emission-Computed; Magnetic Resonance Imaging; Manipulation; Single-Photon; Spinal; Spondylolysis; Tomography.

© 2020 by National University of Health Sciences.

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Figures

Fig 1

Fig 1

Magnetic resonance imaging axial T1-weighted image demonstrated low signal intensity (white arrowheads) bilaterally at the L5 pars interarticularis (A). Axial T2-weighted image demonstrated high signal intensity (white arrows) at the L5 pars, which indicated bilateral grade 1 stress reactions, consisting of neural arch bone marrow edema (B).

Fig 2

Fig 2

Magnetic resonance imaging left parasagittal STIR sequence demonstrated high signal intensity at the L5 pars interarticularis (A; white arrow). Right parasagittal STIR also demonstrated high signal intensity at the L5 pars (B; white arrow). This is consistent with a bilateral grade 1 stress reaction, demonstrating neural arch bone marrow edema.

Fig 3

Fig 3

Magnetic resonance imaging sagittal T2-weighted image demonstrated high signal intensity at the left L5 pars interarticularis (white arrow). There was corresponding low signal intensity on the T1-weighted image (not pictured). This indicated a grade 1 stress reaction with bone marrow edema.

Fig 4

Fig 4

Magnetic resonance imaging right parasagittal T1-weighted (A) and T2-weighted (B) images demonstrated high signal intensity within the L5 pars interarticularis (white arrows). Right parasagittal T2-weighted image with fat suppression demonstrated that the high signal intensity was reduced on fat saturation, suggesting fatty marrow infiltration in response to the defect of the pars interarticularis (C; white arrowhead).

Fig 5

Fig 5

Computed tomography reconstructed axial plane of the L5 vertebral body and posterior elements. Complete spondylolysis of the right pars interarticularis (white arrow) indicated a grade 3 complete active fracture. There was reactive sclerosis in the left pars (white arrowhead), which indicated healing of the spondylolysis.

Fig 6

Fig 6

Computed tomography. Right parasagittal plane demonstrated a grade 3 complete spondylolysis (active fracture) of the L5 pars interarticularis (A; white arrow). Left parasagittal plane demonstrated healing of the spondylolysis in the L5 pars (B; white arrowhead).

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References

    1. Herman MJ, Pizzutillo PD, Cavalier R. Spondylolysis and spondylolisthesis in the child and adolescent athlete. Orthop Clin North Am. 2003;34(3):461–467. - PubMed
    1. Nitta A, Sakai T, Goda Y, Takata Y, Higashino K, Sakamaki T, Sairyo K. Prevalence of symptomatic lumbar spondylolysis in pediatric patients. Orthopedics. 2016;39(3):e434–e437. - PubMed
    1. Leone A, Cianfoni A, Cerase A, Magarelli N, Bonomo L. Lumbar spondylolysis: a review. Skeletal Radiol. 2011;40(6):683–700. - PubMed
    1. Lawrence KJ, Elser T, Stromberg R. Lumbar spondylolysis in the adolescent athlete. Phys Ther Sport. 2016;20:56–60. - PubMed
    1. Haun DW, Kettner NW. Spondylolysis and spondylolisthesis: a narrative review of etiology, diagnosis, and conservative management. J Chiropr Med. 2005;4(4):206–217. - PMC - PubMed

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