Spondylolysis and Spondylolisthesis in the Pediatric Patient

Spondylolysis in youth athletes and active children

Spondylolysis is diagnosed when a stress fracture develops in the pars interarticularis (or "pars" for short) of the lumbar spine. This portion of the spine is vulnerable to injury from the repetitive flexion, extension and rotation common in many sports activities.

The injury to the pars, sometimes called a "pars defect" or "pars fracture") may occur at one or both sides of vertebrae in any section of the spine. It is most common, however, in vertebrae L4 and L5 – the lowest two segments of the lumbar portion of the spine.
 

Spondylolysis in children: Causes, symptoms and diagnosis

Traditionally, spondylolysis has been associated with gymnastics, rowing and football. But HSS is seeing greater numbers of patients with spondylolysis in almost every major sport, including skating, fencing, basketball, football, baseball and cheerleading. This is likely because childhood and adolescent athletics have become more competitive and intense over the years. Today, teenage athletes approach their sports more vigorously and often play multiple sports year-round. In addition to these young athletes, spondylolysis is also seen with greater-than-average frequency in young people who work on family farms and who regularly lift heavy loads.

Back pain is the main complaint, but symptoms of spondylolysis can include leg pain (which is commonly due to hamstring tightness) and muscle spasms. Patients or their parents sometimes mistake this pain to be sciatica, which has similar symptoms. The patient’s posture and gait (manner of walking) may also be affected.

A doctor's assessment begins with a physical examination and X-rays.
 

Nonsurgical treatments and recovery

Most young athletes with spondylolysis can be treated with conservative management. This begins first with a period of rest – ceasing all vigorous sports and heavy weightlifting. In younger patients with acute symptoms of spondylolysis, a back brace is often recommended. Second, once the pain subsides, doctors usually have the patient begin a physical therapy program focused on increasing flexibility in the legs and gentle strengthening of the core muscle groups of the trunk. Third, the patient often prepares to return to sports activity with some more aggressive conditioning, such as running. In the fourth or final phase of treatment, the patient is allowed to return to sports.

However, the parents are asked to modify the child’s activities during his or her first season back in sports. Treatment and recovery may be as short as three months or take as long as a year, he notes. The long-term goal is a full return to sports without restriction.

Although the outlook is good, the diagnosis can come as a shock to young patients.
 

Orthopedic surgery for a child with spondylolysis

A small minority of patients with a pars fracture (sponsylolysis) may continue to experience pain after six months of bracing and rest. In these cases, surgery may be recommended.

Surgical treatment consists of either an arthrodesis (in which the affected vertebra is fused to the adjacent vertebra, thereby restricting motion) or direct repair of the pars fracture. This second approach preserves more motion in the spine. However, fusion has a higher healing rates and fewer incidents in which reoperation (additional surgery) is required.
 

Orthopedic surgery for a child with spondylolysis

A small minority of patients with a pars fracture (sponsylolysis) may continue to experience pain after six months of bracing and rest. In these cases, surgery may be recommended.

Surgical treatment consists of either an arthrodesis (in which the affected vertebra is fused to the adjacent vertebra, thereby restricting motion) or direct repair of the pars fracture. This second approach preserves more motion in the spine. However, fusion has a higher healing rates and fewer incidents in which reoperation (additional surgery) is required.