Spine Deform. 2026 Jul 22. doi: 10.1007/s43390-026-01513-9. Online ahead of print.
ABSTRACT
INTRODUCTION: Lumbar spondylolysis is a common cause of pediatric low back pain. Although CT is highly sensitive, MRI is often used first to avoid radiation. Pars defects may be missed on MRI, potentially delaying care. The frequency and clinical impact of these missed diagnoses remain poorly defined. The purpose of this study is to assess how often spondylolysis is missed on MRI reports.
METHODS: A single-institution retrospective review was performed of pediatric patients with lumbar spondylolysis treated between 2021 and 2024. All patients underwent MRI for evaluation of low back pain. MRI reports were reviewed to determine whether spondylolysis was identified. STIR sequences were examined for pars hyperintensity. Demographic variables, radiologist fellowship training, and time from symptom onset to orthopaedic treatment were recorded. Groups with and without missed MRI diagnoses were compared using independent t tests and Chi-square analyses.
RESULTS: Among 102 patients with spondylolysis, 21 (20.6%) had MRI reports that failed to identify the pars defect. Among missed cases, 13/21 (61.9%) demonstrated hyperintense pars signal on STIR sequences that was not reported. Patients with missed MRI diagnoses had significantly longer delays to treatment initiation compared with those correctly diagnosed (10.6 ± 7.6 vs 6.7 ± 6.4 months from symptom onset; p = 0.042). Fellowship-trained musculoskeletal or neuroradiologists identified spondylolysis in 82.3% of cases compared with 64.7% among non-fellowship-trained radiologists, though this difference was not statistically significant (p = 0.100).
CONCLUSION: Lumbar spondylolysis is missed in ~ 20% of MRI reports, of which the majority demonstrate pathognomonic edema on the STIR sequence. This was associated with significant delays in treatment. There should be a high index of suspicion in pediatric patients with clinical histories suggestive of spondylolysis, even if MRI reports are negative.
PMID:42484990 | DOI:10.1007/s43390-026-01513-9
