Abstract

Purpose: The purpose of this in-depth literature review was to answer the PICO question, “In adolescent and young adult athletes, are surgical interventions or conservative treatment e.g. rest from sport, bracing, and/or physical therapy more effective as a first-line treatment for returning the athlete to their respective sport?”

Background: Spondylolysis, also known as “pars defects”, is a condition where unilateral or bilateral bony defects are present in the vertebral body at the pars interarticularis, a region of the vertebra between the lamina and pedicles. Spondylolysis affects six percent of the general population and is the most common cause of structural low back pain in young children and adolescent athletes. In young athletes the cause is usually an isthmic (stress) fracture caused by repetitive lumbar spinal hyperextension and rotation. First-line treatment usually consists of a period of rest from sports, bracing, followed by a physical therapy regimen. If the young athlete has persistent pain, surgical intervention may be considered. Currently, few studies have looked at the effectiveness of surgical interventions as a first-line treatment versus conservative treatment for the condition in young athletes.

Case: The patient is a 27-year-old male who presents to outpatient physical therapy with chronic low back pain secondary to an initial injury sustained while weight lifting at the age of 20. The patient was originally diagnosed with a back sprain until imaging confirmed presence of bilateral pars defects at the L5-S1 vertebral segments two years after the initial injury, at the age of 22. The patient was seen by multiple medical practitioner’s following the diagnosis for treatment of his low back pain with little success. The patient’s pain had been slowly progressing over the years, limiting the patient from participating in high level activities and sports.

Results: A literature review was conducted and eight studies were selected for final analysis in this paper. Currently, no studies have compared surgical interventions versus conservative management as a first-line treatment for symptomatic spondylolysis in young athletes. What conclusions can be drawn were inferred from the current literature which primarily consists of case series and case reports.

Discussion: The available literature leans towards conservative management as the first-line treatment for acute spondylolysis in young athletes. Currently there is no consensus on the parameters for conservative management but generally the accepted protocol entails rest from sport, bracing, and/or physical therapy. On average, with conservative management, young athletes often return to their sport within 6 months. Surgical interventions while largely associated with good to excellent outcomes should be reserved for those patients who fail conservative management. At this time, it is unknown what the long-term outcomes are of patients who are treated conservatively versus surgically. There is a lack of high-level studies to adequately answer the PICO question. Additional research is needed to guide management of symptomatic spondylolysis in young athletes.

Document Type

Capstone

Degree Name

Doctor of Physical Therapy (DPT)

Keywords

Spondylolysis, Pars Defects, Adolescents, Spondylolysis, Athletes

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