Value Of Routine X-rays Of The Lumbar Spine In Orthopedic Preparticipation Screening

Abstract

BACKGROUND: Considering orthopedic preparticipation screening in athletes of disciplines with high lumbar spine loads, it is unclear whether routinely performed x-rays of the lumbar spine are of additional value in detecting pathologies. Furthermore, it has to be discussed if findings lead to a limitation of eligibility for competitive sports or if medical follow-up examinations and specific training are required. PURPOSE: To analyze radiographic findings of either routinely performed or indicated x-rays of the lumbar spine during preparticipation examinations in young athletes with sport specific loads of the lumbar spine. METHODS: Radiographic findings of the lumbar spine in 325 children (12.2 ± 0.6 years; 173 boys, 152 girls) of an elite sport school were analyzed. Findings were categorized into: 0 = inconspicuous; 1 = findings without clinical relevance (e.g. side deviation, spina bifida occulta); 2 = findings requiring follow-up examinations, physical therapy or specific training (e.g. scoliosis, unilateral spondylolysis); and 3 = findings limiting sports eligibility (spondylolisthesis, spinal instability). Data were analyzed using the Chi Square test and the Fisher Exact test. RESULTS: X-rays were performed in 325 cases. In 21 athletes lumbar pain in history or clinical findings in examination led to additional radiographs. Radiographs were inconspicuous in 285 (88 %), without clinical relevance in 13 (4 %), needed to be controlled in 11 (3 %) and led to a limited sports eligibility in 16 (5 %) children. Findings in 9 of 21 (43 %) indicated and in 18 of 304 (6 %) routinely performed radiographs were classified into grades 2 and 3 (p<0.01). Spondylolisthesis or spinal instability were found in 2 indicated (11 %) and 14 routine x-rays (5 %; p>0.05). CONCLUSION: X-rays of the lumbar spine without any clinical indication have to be questioned in preparticipation screening of young athletes.