The use of bracing in the management of lumbar spondylolysis

Abstract

A 13-year-old female gymnast presents for evaluation of 4 weeks of low back pain. Symptoms are provoked with extension exercises such as vaulting. She was initially evaluated by her primary care physician 3 weeks ago and radiographs obtained at that time demonstrated normal alignment and no bony abnormalities. She was started on a short course of ibuprofen and recommended to avoid painful activity. With an upcoming meet, she continued to practice but avoided vaulting. Despite temporary relief with ibuprofen, her pain gradually worsened over the course of the following week. She was referred for further evaluation and subsequently 3T magnetic resonance imaging findings revealed the presence of changes on both T2 and T1 imaging with fracture line, consistent with spondylolysis bilaterally at L5. Pierre D'Hemecourt and William P. Meehan contributed equally to this study.

Clinical Practice Patterns of Isthmic Spondylolysis in Young Athletes: A Survey of Pediatric Research in Sports Medicine Members

“…Therefore, the authors concluded that bracing does not affect clinical outcome. It also has been suggested that the benefit from bracing is instead due to activity restriction and not from the brace itself (54). Additional studies revealed that a combination of restriction of sport, activity modification, and physical therapy may lead to similar outcomes as brace wear (54).…”

“…Antilordotic orthotic treatment with a rigid or nonrigid brace is a controversial topic but is often utilized in combination with conservative treatments. Duration of brace use is variable and has been recommended for 1 to 16 months (19,22,41,54). In a landmark study, use of a rigid thoracic lumbar sacral orthosis, known as the Boston Overlap Brace (BOB), in addition to PT resulted in successful return to sport in 80% of adolescents with isthmic spondylolysis (41).…”

“…It also has been suggested that the benefit from bracing is instead due to activity restriction and not from the brace itself (54). Additional studies revealed that a combination of restriction of sport, activity modification, and physical therapy may lead to similar outcomes as brace wear (54). However, in the cases of elite athletes, noncompliance with activity restrictions, early defects, bilateral defects or athletes who need to return in a timely manner, bracing may be preferred and may allow a quicker return to sport (54).…”