Surgical Management of Spondylolysis and Spondylolisthesis in Athletes

Abstract

Symptomatic isthmic spondylolisthesis is a common problem in the competitive athlete. Presence of this disorder is recognized easily with imaging studies, although a certain index of suspicion is necessary in the face of normal x-rays. Bone scan, CT scan, and MRI may all play a role in diagnosis. Management of this condition, on the other hand, can be more challenging. There are no high level evidence studies with specific recommendations for bracing, rehab, or surgery. Most athletes successfully return to competition with nonoperative treatment. For those that fail, a pars repair or a fusion are potential options. There are a myriad of techniques advocated for both, and no head to head study has ever proven superiority. Even with fusion, many individuals can return to sports after several months of structured rehab, although a significant number of athletes will fail to resume their pre-injury level of activity.

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review

“…The classic indications for surgery (spondylolysis repair and fusion) are failure of a comprehensive conservative treatment for more than 6 months, persistent back pain and pars non-union at 9-12 months (pars pseudoarthrosis) [57]. Increasing pain, worsening of preexisted neurological impairment and progressive olisthesis are also additional indications for surgical treatment [58].…”

“…L 5 -S 1 ''in situ fusion'' with autogenous iliac crest bone graft is the gold standard for patients with a symptomatic grades I, II L 5 spondylolysis, with success rates approaching 90 % [57]. There are no studies referring to outcomes after posterolateral fusion in athletes.…”

“…The addition of anterior column fixation (interbody grafts) has been promoted to improve both fusion rates and sagittal balance in the general population. However, no evidence-based data exists referring athletes [57].…”

“…Fusion may be career ending surgery for activities that require extreme lumbar hyperextension such as gymnastics or dance [16]. Athletes participating in sports that involve heavy loads may be reduced from highly competitive to recreational [57]. Sports that surgeons forbade athletes to resume after fusion for spondylolisthesis were gymnastics, football, rugby, wrestling, weightlifting, skydiving and bungee jumping.…”

“…Sports that surgeons forbade athletes to resume after fusion for spondylolisthesis were gymnastics, football, rugby, wrestling, weightlifting, skydiving and bungee jumping. However, other authors allow unrestricted return to competition regardless of the sport in those patients who are asymptomatic, have achieved stable fusion, and are fully rehabilitated to their previous playing capacity [57]. Typically, these athletes are permitted to return to competition within 1 year after surgery.…”