Pathogenesis of Sports-Related Spondylolisthesis in Adolescents

Abstract

We reviewed radiographs and magnetic resonance images of 77 young athletes with spondylolysis and spondylolisthesis (more than 5% vertebral slip) (slip group). The results were compared with similar studies in 88 patients with spondylolysis only (nonslip group). Endplate lesions were found in all patients in the slip group and in 60 (68%) of those in the nonslip group. Slippage between the osseous and cartilaginous endplates was identified in the T1-weighted sagittal magnetic resonance images and categorized according to the type of slippage: total slip of L-5 or S-1, partial slip of L-5 or S-1, or a combination of these (mixed type). In a study of 31 patients whose slippages progressed, no slippage was associated with the early stage of a pars interarticularis defect. Most vertebral slippages developed or progressed in the cartilaginous or apophyseal stage of the lumbar skeletal age. Wedging of the L-5 vertebral body and rounding of the sacrum progressed as the slippage developed; these did not occur in the nonslip group. These results indicate that the advanced stage of a pars interarticularis defect in an immature spine is a risk factor for spondylolisthesis. The deformities of the lumbosacral spine are thought to be the secondary changes caused by vertebral slippage.

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].…”

“…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.…”

Sport injuries in the paediatric and adolescent patient: a growing problem

“…However, it remains unclear whether this staging is Spondylolisthesis can be graded on lateral/sagittal views as ≤50% slippage, which is considered stable, and >50% slippage, which is unstable [28]. Vertebral deformation with wedging and disc protrusion/degeneration appears to be secondary to spondylolisthesis instead of being a contributing factor [29].…”