Natural history of lumbar spondylolysis—advances and concerns

Abstract

Lumbar spondylolysis is a common cause of low back pain in adolescents and young adults. Due to a lack of understanding to the natural history, its treatment is often chaotic and controversial. Lumbar spondylolisthesis is a common complication of spondylolysis, but slip progression was commonly small and slow according to long-term follow-up studies. Many predisposing risk factors have been identified as associated with a great chance of slip progression. However, the widely accepted mechanism leading to adult slip progression is related to disc degeneration at the slip level. Clinical decision made for patients presenting with spondylolysis and spondylolisthesis principally include concerns for future progression of the spondylolisthesis and issues concerning pain. Most patients with spondylolysis and/or spondylolisthesis respond to conservative treatment. Surgical treatment is generally thought for patients who fail to respond to conservative treatment.