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Occult Spondylytic Fractures


- See: Back Pain in Children

- Discussion:
    - occult frxs typically occur after minor injuries, such as falls during sports-related activities;
    - most occult fractures heal spontaneously in 8 months;
    - diff dx:
          - disc-space infection
          - osteoid-osteoma
          - spinal cord tumor
          - slipped vertebral apophysis
          - herniated disc
          - scheuermann disease
          - rheumatoid spondylitis

- Exam:
     - most sensitive finding is pain with back extension

- Radiographs:
    - frx may not be visible on plain roentgenograms;
    - if patient has persistent pain, a technetium bone may be useful for localization of occult frx, as MRI can miss
              the diagnosis;

- Treatment:
    - restriction of athletic activities:
           - restrict activity until acute symptoms have resolved, followed by institution of a rehabilitation program;
     - immobilization w/ orthosis:
           - immoblization may be necessary to relieve pain if decreasing activity does not relieve pain;


References:

Back pain in athletes.

Spondylolisthesis and spondylolysis.