Lumbar Spondylolysis in the Pediatric Population: A Retrospective CT Review With Radiology Rereview
Bibliographic record
Abstract
INTRODUCTION: Spondylolysis, a defect in the pars interarticularis, can be symptomatic or asymptomatic with an estimated prevalence of 4% by age 6 years and 6% by adulthood. This study's goal was to determine the prevalence of lumbar spondylolysis found on CT scans in children and to characterize patient-specific risk factors. METHODS: Abdominopelvic CT scans done (2017 to 2020) in patients up to age 18 years were reviewed. The radiology report was retrospectively reviewed for a spondylolysis, and a radiologist rereviewed the CT scan. Patient demographics and indications for CT scan were included. Firth bias-reduced logistic regression was used to model spondylolysis with each demographic variable as a predictor. RESULTS: One thousand nine hundred thirty-one CT reports and imaging were reviewed; abdominal pain (41.91%) and trauma (29.46%) were the most common reasons for CT scan. Spondylolysis was found in 42 patients (2.18%) per the radiology report and in 71 patients (3.68%) on radiologist overread. Median age was 13 years (interquartile range, 10 to 16 years). Age groups had the following prevalence: 0 to 6 years (0.41%); 7 to 10 years (1.58%); 11 to 13 years (3.59%); 14 to 18 years (5.1%). Increased prevalence was found in ages 14 to 18 years that was statistically significant (odds ratio 1; P = 0.0004). L5 was the most common level; most defects were bilateral. White patients had a higher rate of spondylolysis (5.06%) than Black patients (2.05%). Black patients were less likely to have a spondylolysis with an OR of 0.4 (0.22 to 0.69; P = 0.0007). DISCUSSION: This study demonstrated a lower prevalence of lumbar spondylolysis (3.68%) in children compared with the previous literature. Increasing prevalence with age suggests that spondylolysis develops over time, likely because of repetitive stress. Future studies should characterize these age-related and race-related differences for better understanding. LEVEL OF EVIDENCE: Level IV, retrospective.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".