Spondylolysis in Young Athletes: An Overview Emphasizing Nonoperative Management

Abstract

Lumbar spondylolysis is a unilateral or bilateral defect of the pars interarticularis, an isthmus of bone connecting the superior and inferior facet surfaces in the lumbar spine at a given level. Spondylolysis is common in young athletes participating in sports, particularly those requiring repetitive hyperextension movements. The majority of young athletes are able to return to full sport participation following accurate diagnosis and conservative management, including a structured treatment program. Surgical intervention for isolated pars injuries is seldom necessary. A progressive physical therapy (PT) program is an important component of recovery after sustaining an acute pars fracture. However, there is a paucity of literature detailing PT programs specific to spondylolysis. Here, we provide an overview of the epidemiology, natural history, radiographic evaluation, and management of pars fractures in young athletes. In addition, a detailed description of a physiotherapy program for this population that was developed at a spine center within an academic medical center is provided.

Alleviation of Chronic Low Back Pain due to Bilateral Traumatic L4 Pars Interarticularis Fractures Relieved With Steroid Injections

“…LBP causes significant morbidity and carries an estimated healthcare spending cost of $67.5 billion to $94.1 billion annually in the United States [6]. Spondylolysis affects a much smaller portion of the population but is mostly seen in young athletes, such as our patient [1][2][3]. Unfortunately, some of these patients can fail to respond to conservative therapy and may be forced to consider surgery or discontinue their participation in athletic activities.…”

“…Unilateral acute fractures of the pars interarticularis can often heal over time. However, bilateral fractures may progress to spondylolisthesis [2]. These injuries also have an increased risk of neurological deficits and chronic pain [3].…”

“…Conservative therapy is effective in 84%-95% of patients and includes rest, discontinuation of high-impact sports, nonsteroidal anti-inflammatory drugs (NSAIDs), bracing, and physical therapy (PT) [2]. Surgery is reserved for the minority of patients who fail to respond to conservative therapy as it carries the risks of tissue injury, bleeding, infection, and hardware failure [3,4].…”

The use of bracing in the management of lumbar spondylolysis

“…Other sports at elevated risk for this injury include activities with extension‐based movements such as participation in football (particularly lineman), dancers, weightlifters, and rowers 7 . Congenital factors such as spina bifida occulta, scoliosis, Scheuermann's disease, and exaggerated lumbar lordosis may also predispose individuals to pars interarticularis fractures 8 …”

Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET

“…3). 78 A common cause of low back pain in young athletes is spondylolysis, defined as a defect or stress fracture involving the pars interarticularis that commonly affects the lumbar spine. Pars fractures show increased bone turnover until the bone is finished healing.…”