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.
Highlights
Lumbar spondylolysis is a defect in the pars interarticularis, and primarily involves the L5 vertebra, accounting for 85-95% of all cases (Figure 1)
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
Summary
Lumbar spondylolysis is a defect in the pars interarticularis, and primarily involves the L5 vertebra, accounting for 85-95% of all cases (Figure 1). Several authors have reported a hereditary predisposition, citing a high rate of occurrence among family members, with an incidence of up to 69%[8,9] as well as a strong association with spina bifida occulta[10] These reports lend credence to the theory of an underlying dysplasia, which may be characterized by hypoplasia and elongation or sclerosis of the pars interarticularis. Dysplasia would represent a factor that predisposes the patient to the occurrence of lysis, the actual onset of which would be triggered by the mechanical trauma[9] This pathogenetic sequence of events is supported by the fact that spondylolysis is most common at L5 level, which is the vertebra subjected to the greatest amount of stress associated with daily activities[10]
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