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Starts at the Inferior Cortex, Spares the Superior Cortex — The True Signature of a Grade 2 Pars Stress Injury
Incomplete spondylolysis (Grade 2 pars stress fracture) is an early-stage fatigue fracture of the pars interarticularis, most frequently seen in adolescent athletes involved in high-extension sports.
According to the 2008 Skeletal Radiology study, every incomplete fracture begins in the inferior or inferomedial cortex and never extends through the superior cortex in its early phase.
This creates a lesion that looks deceptively normal unless the inferior cortex is examined carefully.
CT is the gold standard.
Characteristic findings include:
- A small cortical cleft limited to the inferior cortex
- An intact superior cortex
- High-attenuation reactive sclerosis surrounding the defect
- A predictable inferior → superior propagation pattern
MRI STIR reliably detects bone marrow edema, but often fails to depict the cortical break accurately; therefore, MRI alone can misclassify incomplete fractures.
Early recognition is clinically significant.
Incomplete fractures have an excellent healing rate (>80%) with proper activity modification.
However, missed lesions—especially when bilateral—carry a markedly higher risk of progressing to a complete pars defect, reducing healing potential and increasing long-term morbidity.
Incomplete spondylolysis is subtle, but not invisible.
Radiologists and sports clinicians must deliberately inspect the inferior cortex to prevent progression from a reversible stress injury to a permanent defect.
#IncompleteSpondylolysis, #ParsFracture, #LumbarSpine, #SpondylolysisImaging, #SportsMedicineRadiology, #PediatricAthlete, #CTSpine, #MRI_STIR, #MSKRadiology, #StressFractureDetection, #Vibecase
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