Abstract
Lumbar spondylolysis is a unilateral or bilateral defect of the pars interarticularis, an isthmus of bone connecting the superior and inferior facet surfaces in the lumbar spine at a given level. Spondylolysis is common in young athletes participating in sports, particularly those requiring repetitive hyperextension movements. The majority of young athletes are able to return to full sport participation following accurate diagnosis and conservative management, including a structured treatment program. Surgical intervention for isolated pars injuries is seldom necessary. A progressive physical therapy (PT) program is an important component of recovery after sustaining an acute pars fracture. However, there is a paucity of literature detailing PT programs specific to spondylolysis. Here, we provide an overview of the epidemiology, natural history, radiographic evaluation, and management of pars fractures in young athletes. In addition, a detailed description of a physiotherapy program for this population that was developed at a spine center within an academic medical center is provided.
Highlights
A parent or legal guardian must provide verbal and/or written consent to allow for the treatment of a minor. ey can be a valuable source of information to fully understand the patient’s medical and surgical history, psychosocial factors, previous activity, and current functional level
When caring for athletic patients, we recommend documenting a detailed description of the requirements of the individual’s sport including the following: type of activity, hours in practice, level of competition, conditioning routine and intensity, and additional training related to performance
Most importantly, gathering specifics on provocative movements or activities performed during sports participation will prove valuable when developing a plan for treatment intervention and goal-setting
Summary
Spondylolysis is a unilateral or bilateral defect of the pars interarticularis, an isthmus of bone connecting the superior and inferior facet surfaces in the spine at a given level (Figure 1). e pars defect may either be an acute fracture or a chronic osseous disruption with sclerotic borders. e condition, which has an incidence of 3–10% in the general population [1], exists on a continuum ranging from pars stress fractures to spondylolisthesis [2]. ose caring for pediatric and young adult patients participating in sports will often encounter spondylolysis which typically presents as low back pain with specific activity (i.e., lumbar extension/ rotation during throwing, lumbar hyperextension, and loading during back handspring). e majority of young athletes are able to return to full sport participation following accurate diagnosis and conservative management, including a structured treatment program. erefore, surgical intervention for isolated pars injuries is seldom necessary. E majority of young athletes are able to return to full sport participation following accurate diagnosis and conservative management, including a structured treatment program. We provide an overview of the epidemiology, natural history, radiographic evaluation, and management of pars fractures in young athletes. In the short-term following injury, typically defined as six weeks, the majority of patients with spondylolysis will symptomatically improve, and the majority of athletes return to usual sporting activity [7]. Advanced imaging modalities can be more sensitive than plain film x-rays in the diagnosis of spondylolysis. In terms of cost of imaging evaluation, a 2013 study evaluated two-view and four-view plain films to CT, bone scan, and MRI. 4. Surgical Treatment e vast majority of patients with stress fractures of the lumbar pars interarticularis can be managed successfully without surgery. Modern minimally invasive techniques for direct spondylolysis repair may have superior clinical outcomes over conventional open techniques and may be considered in cases where conservative management has failed [29]
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