Spine

Stress injuries of the spine in runners may occur in the vertebral bodies, pedicles, and in the lamina/pars interarticularis. Patients most commonly complain of low back pain (Fig. 16) [90].

MRI of stress response typically shows intramedullary low T1 signal and corresponding increased T2, fat-saturated or STIR signal intensity, and may show enhancement of the corresponding marrow as well as surrounding soft tissues after contrast administration. An actual stress fracture will show the above findings associated with stress response, with the additional finding of a low T1, low T2 signal intensity line extending to the cortex representing the fracture plane [24,34-36].

Stress Fracture Lower Back
Fig. 15. Axial T2 FSE FS. Sacral stress fracture. 44-year-old radiologist and ultramarathon runner who developed low back and pelvic pain. There is increase signal intensity in the right side of the sacrum consistent with stress response. A subtle fracture line is evident (arrow).
What Pedicle Fracture
Fig. 16. Axial CT. Bilateral pedicle stress fractures. 14-year-old soccer player with pain that developed during running. Stress fractures of the pedicles (arrows) surrounded by transverse sclerosis on CT.

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