Spondylolysis 2019 update

Purpose of review Provide a comprehensive overview of lumbar spondylolysis, a frequent cause of lower back pain in children and adolescents, from evaluation to management. Recent findings With the surge of structured sports participation in the pediatric population, spondylolysis is a common ailment that afflicts many young athletes due to rigorous competition that taxes the growing spine with repetitive extension and rotation. Summary Spondylolysis is a fracture through the pars interarticularis. When a child presents with lower back pain, spondylolysis should be at the top of the differential. A thorough history and physical examination are essential. In addition, radiographs of the lumbar spine, anterior posterior and lateral views, MRI and, selectively, computed tomography are useful adjuncts to uncover a pars injury. Timely diagnosis facilitates early treatment which includes rest, optimizing bone health, brace treatment, and physical therapy. If delayed or untreated, spondylolysis may result in nonunion or pars defect. If symptomatic, patients may need surgery to fuse the lumbar facet joints or repair the par interarticularis.

[1]  B. Scammell,et al.  Predictive Factors for the Outcome of Surgical Treatment of Lumbar Spondylolysis in Young Sporting Individuals , 2017, Global spine journal.

[2]  B. Morel,et al.  The prevalence of lumbar spondylolysis in young children: a retrospective analysis using CT , 2018, European Spine Journal.

[3]  Scott E. Sheehan,et al.  Sports and the Growing Musculoskeletal System: Sports Imaging Series. , 2017, Radiology.

[4]  S. Weinstein,et al.  Imaging Pediatric Spondylolysis: A Systematic Review , 2017, Spine.

[5]  Michael P. Silverstein,et al.  Review of Pediatric Spondylolysis and Spondylolisthesis , 2016, Sports medicine and arthroscopy review.

[6]  B. Heyworth,et al.  Overuse Injuries in the Pediatric Population , 2016, Sports medicine and arthroscopy review.

[7]  K. Sairyo,et al.  Characteristics of lumbar spondylolysis in elementary school age children , 2016, European Spine Journal.

[8]  Ho-Joong Kim,et al.  Comparison of surgical treatment with direct repair versus conservative treatment in young patients with spondylolysis: a prospective, comparative, clinical trial. , 2015, The spine journal : official journal of the North American Spine Society.

[9]  J. Buchowski,et al.  Current Evidence Regarding the Surgical and Nonsurgical Treatment of Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence-Based Medicine Committee , 2015, Spine deformity.

[10]  J. Buchowski,et al.  Current Evidence Regarding the Etiology, Prevalence, Natural History, and Prognosis of Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence-Based Medicine Committee , 2014, Spine deformity.

[11]  Amit Jain,et al.  Clinical Results and Functional Outcomes After Direct Intralaminar Screw Repair of Spondylolysis , 2012, Spine.

[12]  J. Flynn,et al.  Imaging Modalities for Low Back Pain in Children: A Review of Spondyloysis and Undiagnosed Mechanical Back Pain , 2013, Journal of pediatric orthopedics.

[13]  H. Higuchi,et al.  Diagnosis of Radiographically Occult Lumbar Spondylolysis in Young Athletes by Magnetic Resonance Imaging , 2013, The American journal of sports medicine.

[14]  K. Ryschon,et al.  Should 25-Hydroxyvitamin D and Bone Density Using DXA be Tested in Adolescents With Lumbar Stress Fractures of the Pars Interarticularis? , 2012, Journal of spinal disorders & techniques.

[15]  K. Sairyo,et al.  Conservative treatment for pediatric lumbar spondylolysis to achieve bone healing using a hard brace: what type and how long?: Clinical article. , 2012, Journal of neurosurgery. Spine.

[16]  Sang-Wook Lee,et al.  Prevalence of Spondylolysis and Its Relationship with Low Back Pain in Selected Population , 2011, Clinics in orthopedic surgery.

[17]  L. Bonomo,et al.  Lumbar spondylolysis: a review , 2011, Skeletal Radiology.

[18]  E. Mortimer,et al.  Upper extremity stress fractures and spondylolysis in an adolescent baseball pitcher with an associated endocrine abnormality: a case report. , 2010, Journal of pediatric orthopedics.

[19]  K. Sairyo,et al.  Incidence and etiology of lumbar spondylolysis: review of the literature , 2010, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[20]  C. Mehlman,et al.  Nonoperative Treatment of Spondylolysis and Grade I Spondylolisthesis in Children and Young Adults: A Meta-analysis of Observational Studies , 2009, Journal of pediatric orthopedics.

[21]  R. Campbell,et al.  Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis , 2008, Skeletal Radiology.

[22]  K. Grimmer-Somers,et al.  Epidemiology of Adolescent Spinal Pain: A Systematic Overview of the Research Literature , 2007, Spine.

[23]  Deborah M. Eastwood,et al.  Lovell and Winter’s Pediatric Orthopaedics, 6th edition , 2007 .

[24]  J. Congeni,et al.  Current concepts in the diagnosis and treatment of spondylolysis in young athletes , 2007, Current sports medicine reports.

[25]  V. Goel,et al.  Buck's direct repair of lumbar spondylolysis restores disc stresses at the involved and adjacent levels. , 2006, Clinical biomechanics.

[26]  K. Bennell,et al.  Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis , 2006, British Journal of Sports Medicine.

[27]  V. Goel,et al.  MRI Signal Changes of the Pedicle as an Indicator for Early Diagnosis of Spondylolysis in Children and Adolescents: A Clinical and Biomechanical Study , 2006, Spine.

[28]  B. Latimer,et al.  Human Evolution and the Development of Spondylolysis , 2005, Spine.

[29]  K. Sairyo,et al.  Union of defects in the pars interarticularis of the lumbar spine in children and adolescents. The radiological outcome after conservative treatment. , 2004, The Journal of bone and joint surgery. British volume.

[30]  Moe R. Lim,et al.  Symptomatic spondylolysis: diagnosis and treatment , 2004, Current opinion in pediatrics.

[31]  B. Fredrickson,et al.  The Natural History of Spondylolysis and Spondylolisthesis: 45-Year Follow-up Evaluation , 2003, Spine.

[32]  Bryan W. Smith,et al.  Back injuries in the pediatric athlete. , 2002, Current sports medicine reports.

[33]  G. Logroscino,et al.  Spondylolysis and spondylolisthesis in the pediatric and adolescent population , 2001, Child's Nervous System.

[34]  S. Herring,et al.  Spondylolysis: a critical review , 2000, British journal of sports medicine.

[35]  J. Congeni.  Evaluating spondylolysis in adolescent athletes , 2000 .

[36]  L. Micheli,et al.  Back injuries in the young athlete. , 2000, Clinics in sports medicine.

[37]  U. Kujala,et al.  The Prevalence of Low Back Pain Among Children and Adolescents: A Nationwide, Cohort‐Based Questionnaire Survey in Finland , 1997, Spine.

[38]  L. Micheli,et al.  Back injuries in the young athlete. , 2000, Clinics in sports medicine.

[39]  C. Merbs,et al.  Incomplete Spondylolysis and Healing: A Study of Ancient Canadian Eskimo Skeletons , 1995, Spine.

[40]  S. Katoh,et al.  Lumbar spondylolysis in children and adolescents. , 1995, The Journal of bone and joint surgery. British volume.

[41]  L. Micheli,et al.  Back pain in young athletes. Significant differences from adults in causes and patterns. , 1995, Archives of pediatrics & adolescent medicine.

[42]  R. Fraser,et al.  Stress Fracture of the Lumbar Pedicle Case Reports of “Pediculolysis” and Review of the Literature , 1991, Spine.

[43]  C. Merbs.  Spondylolysis: its nature and anthropological significance , 1989 .

[44]  J. Lubicky,et al.  The natural history of spondylolysis and spondylolisthesis. , 1984, The Journal of bone and joint surgery. American volume.

[45]  W. Bargar,et al.  The Incidence of Spondylolysis and Spondylolisthesis in Nonambulatory Patients , 1981, Spine.

[46]  F Rossi,et al.  Spondylolysis, spondylolisthesis and sports. , 1978, The Journal of sports medicine and physical fitness.

[47]  D. W. Jackson,et al.  Spondylolysis in the female gymnast. , 1976, Clinical orthopaedics and related research.

[48]  J. Troup,et al.  The structure of the pars interarticularis of the lower lumbar vertebrae and its relation to the etiology of spondylolysis, with a report of a healing fracture in the neural arch of a fourth lumbar vertebra. , 1973, The Journal of bone and joint surgery. British volume.

[49]  M. Roche,et al.  The incidence of separate neural arch and coincident bone variations. A survey of 4,200 skeletons , 1951, The Anatomical record.