Spondylolysis in the adolescent athlete

Purpose of review Spondylolysis is a common cause for back pain in the adolescent athlete. Increased awareness of the presentation of this subset of patients can aid in optimal outcomes. This paper aims to review the typical presentation of spondylolysis in the adolescent with specific focus on the adolescent athlete. We review current controversies in diagnosis and management and aim to provide a thorough review to aid the pediatrician in making clinical decisions for this subset of patients. Recent findings The optimal algorithm for diagnostic imaging is controversial. Single positron emission computerized tomography can provide good sensitivity but poor specificity for spondylolysis. Computerized tomography can be useful as a follow-up exam to visualize the bony anatomy and osseous healing but has the concern of high radiation exposure. MRI may be a useful tool for diagnosis and follow-up examination, which may have significant advantages over traditional imaging techniques. Brace use is controversial and most likely functions as an adjunct for limiting motion to promote activity restrictions. Summary Spondylolysis in the adolescent athlete is a common problem. MRI is a good study for diagnosis, although further studies need to be done in order to show its advantages over traditional diagnostic methods. Brace wear is encouraged as a method for promoting activity modification, although its efficacy in promoting healing and success in treating spondylolysis is controversial.

[1]  K. Sairyo,et al.  Conservative treatment of lumbar spondylolysis in childhood and adolescence: the radiological signs which predict healing. , 2009, The Journal of bone and joint surgery. British volume.

[2]  H. Watts,et al.  Diagnostic Modalities for the Evaluation of Pediatric Back Pain: A Prospective Study , 2008, Journal of pediatric orthopedics.

[3]  A. Vaccaro,et al.  Nonoperative Treatment of Symptomatic Spondylolysis , 2007, Journal of spinal disorders & techniques.

[4]  S. Herring,et al.  Expert opinion and controversies in sports and musculoskeletal medicine: the diagnosis and treatment of spondylolysis in adolescent athletes. , 2007, Archives of physical medicine and rehabilitation.

[5]  Bruce Rothschild,et al.  Lumbar Facet Orientation in Spondylolysis: A Skeletal Study , 2007, Spine.

[6]  S. Peleg,et al.  Lumbar facet anatomy changes in spondylolysis: a comparative skeletal study , 2007, European Spine Journal.

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

[8]  B. Latimer,et al.  Radiographic Assessment of Lumbar Facet Distance Spacing and Spondylolysis , 2007, Spine.

[9]  J. Grauer,et al.  Back Pain in Athletes , 2006, The Journal of the American Academy of Orthopaedic Surgeons.

[10]  A. Day,et al.  Lumbar spine injuries in athletes. , 2006, Neurosurgical focus.

[11]  D. Schlenzka,et al.  Long-term Outcome After Posterolateral, Anterior, and Circumferential Fusion for High-Grade Isthmic Spondylolisthesis in Children and Adolescents: Magnetic Resonance Imaging Findings After Average of 17-Year Follow-up , 2006, Spine.

[12]  A. Green,et al.  Lumbar spine reposition sense: the effect of a 'slouched' posture. , 2006, Manual therapy.

[13]  M. Herman,et al.  Spondylolysis and spondylolisthesis in children and adolescents: I. Diagnosis, natural history, and nonsurgical management. , 2006, The Journal of the American Academy of Orthopaedic Surgeons.

[14]  A. Haig,et al.  Changes in Posture and Perceived Exertion in Adolescents Wearing Backpacks with and without Abdominal Supports , 2006, American journal of physical medicine & rehabilitation.

[15]  Á. Ruiz-Cotorro,et al.  Spondylolysis in young tennis players , 2006, British Journal of Sports Medicine.

[16]  M. Takemitsu,et al.  Low Back Pain in Pediatric Athletes With Unilateral Tracer Uptake at the Pars Interarticularis on Single Photon Emission Computed Tomography , 2006, Spine.

[17]  K. Cassas,et al.  Childhood and adolescent sports-related overuse injuries. , 2006, American family physician.

[18]  M. DeLano,et al.  Lumbar spine MRI in the elite-level female gymnast with low back pain , 2006, Skeletal Radiology.

[19]  I. Sanpera,et al.  Bone Scan as a Screening Tool in Children and Adolescents With Back Pain , 2006, Journal of pediatric orthopedics.

[20]  G. Glancy.  The diagnosis and treatment of back pain in children and adolescents: an update. , 2006, Advances in pediatrics.

[21]  W. Boissonnault,et al.  Differential diagnosis of spondylolysis in a patient with chronic low back pain. , 2005, The Journal of orthopaedic and sports physical therapy.

[22]  E. Cohen,et al.  Magnetic resonance imaging in diagnosis and follow-up of impending spondylolysis in children and adolescents: early treatment may prevent pars defects , 2005, Journal of pediatric orthopedics. Part B.

[23]  G. Macfarlane,et al.  Epidemiology of low back pain in children and adolescents , 2005, Archives of Disease in Childhood.

[24]  J. Iwamoto,et al.  Returning athletes with severe low back pain and spondylolysis to original sporting activities with conservative treatment , 2004, Scandinavian journal of medicine & science in sports.

[25]  Stephen F. Miller,et al.  Long-Term Functional and Anatomical Follow-Up of Early Detected Spondylolysis in Young Athletes , 2004, The American journal of sports medicine.

[26]  J. Sýs,et al.  Nonoperative treatment of active spondylolysis in elite athletes with normal X-ray findings: literature review and results of conservative treatment , 2001, European Spine Journal.

[27]  A. Saifuddin,et al.  The value of lumbar spine MRI in the assessment of the pars interarticularis. , 1997, Clinical radiology.

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