Spondylolysis

Abstract

The treatment of spondylolysis of adolescent athletes remains a controversial subject. Electrical stimulation treatment has been used in attempts to heal non-healing fractures throughout the body, most commonly with the treatment of long bone fractures. It is believed that using electrical stimulation helps mimic the negative potential created by the body's normal electrical impulses. Recreating this natural healing process is what is believed to heal painful bony nonunions. Using electromagnetic fields has been shown to be successful healing painful nonunions in long bones. We have hypothesized that this same technology can be used to heal refractory spondylolytic lesions that remain symptomatic. PURPOSE To determine if the use of electrical stimulation on adolescent athletes with painful spondylolysis will improve healing. METHODS We retrospectively reviewed 79 consecutive patients (41 females and 38 males; mean age 15 years; range 11–20 years) diagnosed with spondylolysis who were treated with electrical stimulation. Length of time of electrical stimulation usage was reviewed as was bracing and return to sports. Healing was measured as bony union confirmed by radiography and functional healing determined by resolution of symptoms. The mean follow up period was 15.4 months (range 2 to 43 months). RESULTS The electrical stimulation units were worn for an average of 5.5 months (2–20 months). Every patient was treated with a Boston overlapping brace (BOB) for an average time of 8 months (range 2–27 months). Complete bony union was demonstrated in twenty-one patients (27%). Eight patients demonstrated progressive healing (10%) and fifty patients showed nonunion (63%). Sixty-seven patients were pain free at their final follow up visit (85%), eleven patients (14%) reported moderate pain and one patient reported severe pain (1%). All 79 patients returned to sports with an average time of 4.8 months (range 0–30 months). CONCLUSION Electrical stimulation shows promise as a modality to heal painful nonunions in the treatment of acute spondylolysis in the adolescent athlete.