Lumbar spondylolysis in children and adolescents

Abstract

We investigated 185 adolescents under the age of 19 years with spondylolysis. All but five were active in sport. The pars defect was classified into early, progressive and terminal stages.Of the 346 pars defects in 185 patients, 39.6% were early, 29.5% progressive and 30.9% in the terminal stages. Conservative management produced healing in 73.0% of the early, 38.5% of the progressive and none of the terminal defects.These results suggest that spondylolysis is caused by repetitive microtrauma during growth and can be successfully treated conservatively if treatment is started in the early stage. There was elongation of the pars interarticularis as the pars defect progressed, and this is likely to be a consequence of the defect rather than a contributing cause.

Nonoperative treatment of active spondylolysis in elite athletes with normal X-ray findings: literature review and results of conservative treatment

“…We could not confirm this direct relation between the appearance of symptoms and healing pattern in the present study. Assuming that a stress reaction, an active fatigue fracture, inactive spondylolysis and (pseudo-) bilateral spondylolysis are the consecutive stages of untreated overuse at the pars interarticularis, this study still does confirm the importance of early diagnosis and treatment [4,8,16,22,23,35].…”

“…In adolescent and young adult athletes, special attention should be paid to fatigue fractures of the pars interarticularis, because of their possible evolutive nature [8,11,16,18,34,35,48].…”

“…It may be assumed that a stress reaction, a micro-fracture, an overt fracture, and spondylolisthesis can be the consecutive stages of the same overuse injury at the pars interarticularis [4,8,16,22,23,35]. No single imaging or scintigraphic technique allows differentiation between these stages.…”

“…No single imaging or scintigraphic technique allows differentiation between these stages. Several authors have distinguished between early, progressive and terminal stages, either with X-ray [35], CT scan [8], or magnetic resonance imaging (MRI) [22]. Rather than using the terms "acute" or "chronic", "early" or "late", we prefer using the terms "active" and "inactive", related to the appearance on SPECT scintigraphy.…”

“…If diagnosis is made prior to the development of an overt fracture, the nonoperative treatment is more likely to succeed [16,22,35]. 2.…”