Effectiveness of surgical versus conservative treatment for symptomatic unilateral spondylolysis of the lumbar spine in athletes: a systematic review protocol

Abstract

Review question/objective This systematic review aims to determine the effectiveness of surgical fixation, performed after a trial period of conservative management, compared to conservative management only for unilateral spondylolysis in athletes. More specifically, the objectives are: To assess whether surgical fixation compared to conservative management of unilateral spondylolysis allows athletes to return to their regular sport more rapidly. To identify which intervention is more effective in supporting the athlete to resume pre-injury function. Inclusion criteria Types of participants This review will consider studies in which participants are athletes with symptomatic unilateral spondylolysis of the lumbar spine. Athletes will be defined as individuals under the age of 50 competing in regular organised sporting activities. Both professional and amateur athletes will be considered participating in any type of sport. For participants to be included in the review unilateral spondylolysis has to be radiologically diagnosed in athletes with back pain using CT scanning, MRI or by Single-photon Emission Computed Tomography (SPECT) scanning. An inclusive approach will be adopted with respect to the geographical location of studies with participants from all countries and health care settings to be considered. Only studies where participants have first undergone a trial of conservative treatment prior to surgical intervention will be considered, as this is the current recommended practice. Types of intervention and comparators Surgical interventions, which attempt a direct repair of the pars interarticularis, will be considered for this review. Even though direct repair in the form of Buck's Repair is the most widely recommended surgical treatment for spondylolyis, other surgical techniques including segmental wire fixation and pediculolaminar hook screws have also been shown to be effective and will hence be included in the review.Given that this is a rare procedure and that spondylolyis procedures are only completed in specialist spinal surgery units it is likely that the surgeries will only be performed by a highly qualified specialist and therefore no studies will be excluded on the basis of who is performing the surgery. The comparators are the conservative treatments commonly used to treat unilateral spondylolyis in athletes and allow return to sport including, but not limited to rest, activity modification, bracing, lumbar stability exercises, pharmacological treatment and physical therapy. Types of outcomes The primary outcomes of interest in this review are return to sport, length of time before return to sport and level of sporting activity after treatment. With respect to measures of outcomes, a yes/no response will indicate return to sport, which may be gathered by patient observation or report. All objective and subjective measures of time to return to sport and level of post treatment sporting participation/activity level will be considered. Overall function and pain are secondary outcomes for the review.