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Flexion-extension lateral radiographs
12%
446/3657
Oblique radiographs of the of the lumbosacral spine
14%
506/3657
Single photon emission computed tomography (SPECT)
67%
2441/3657
Indium-labeled bone scan
6%
233/3657
Ultrasound
0%
14/3657
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Of the listed answers, single photon emission computed tomography (SPECT) is the most sensitive imaging modality to diagnose spondylolysis when AP and lateral radiographs are normal. Initial imaging studies should first include AP and lateral radiographs, which demonstrate 80% of defects, and oblique radiographs which demonstrate an additional 15% of defects. If no lesion is seen on plain radiogaphs, SPECT can be considered as a diagnostic study. Conventional lumbar spine MRI techniques are valuable for demonstrating normality of the pars, but may be associated with a high false positive rate for the diagnosis of pars defects. The cited reference by Gregory et al. showed that single photon emission computerized tomography can be an effective tool to diagnosis spondylolysis in young patients with back pain. Illustration A, B, and C demonstrate single photon emission computed tomography images in a patient with spondylolysis.
2.3
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