The lumbar spine of the young cricket fast bowler: an MRI study.

OBJECTIVES: To describe the prevalence and nature of lumbar spinal abnormalities in adolescent cricket fast bowlers.

DESIGN: Observational study.

METHODS: 46 asymptomatic fast bowlers aged 13-18 years participated in the study and were grouped into under-15 (U15), under-17 (U17) and under-19 (U19) classifications. All participants underwent magnetic resonance imaging of the lumbar spine and abnormalities of the pars interarticularis and intervertebral discs were graded according to type and severity. Other abnormalities were also noted.

RESULTS: Fifteen bowlers (33%) had at least one pars interarticularis abnormality. Six bilateral and 10 unilateral defects were identified. Of the 10 unilateral pars abnormalities, 6 occurred on the non-dominant side. Nineteen of the abnormalities occurred at the L5 vertebral level, 2 at L4 and 1 at L3. The most common type of pars abnormality was the subtotal stress fracture, which was found in 38% of bowlers aged 16 years and under. Sixteen participants (35%) were found to have degeneration of at least 1 lumbar disc and the prevalence increased with each successive age group (29% U15, 33% U17 and 43% U19). Of the 25 discs with signs of degeneration, 9 occurred at L4/5 and 7 at L5/S1. Eleven of these were classified as mild degeneration, 13 as moderate, and 1 as severe. Disc bulges were found in 33% of participants.

CONCLUSIONS: Lumbar radiological abnormalities are common in asymptomatic adolescent fast bowlers. Acute bone stress reactions of the lumbar pars interarticularis are visible on magnetic resonance imaging and, in some instances, occur before the onset of activity-related pain.