Spondylolysis and spondylolisthesis in child and adolescent athletes: Management
- James M Daniels, MD, MPH, RMSK
James M Daniels, MD, MPH, RMSK
- Professor of Family & Community Medicine and Orthopedic Surgery
- Vice Chair and Director of Scholarly Activity
- Department of Family & Community Medicine
- Southern Illinois University School of Medicine
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Among child and adolescent athletes, spondylolysis typically represents a fracture of the posterior arch in the lower lumbar spine due to overuse and is a relatively common cause of low back pain. Spondylolisthesis involves anterior displacement of a vertebral body due to bilateral defects of the posterior arch and is less common than spondylolysis. In the large majority of cases, treatment consisting primarily of rest and symptom management allows children and adolescents to recover from these conditions without complications.
The management of spondylolysis and spondylolisthesis in child and adolescent athletes is reviewed here. The clinical presentation and diagnosis of these conditions, and the assessment of unspecified back pain in children, are discussed separately. (See "Spondylolysis and spondylolisthesis in child and adolescent athletes: Clinical presentation, imaging, and diagnosis" and "Evaluation of the child with back pain" and "Back pain in children and adolescents: Overview of causes".)
INITIAL MANAGEMENT WHEN SPONDYLOLYSIS IS SUSPECTED
Ruling out dangerous causes of back pain — Patients, particularly younger children, with a potentially dangerous cause of low back pain must be worked up appropriately; their care is reviewed in detail separately. (See "Evaluation of the child with back pain".)
Symptoms and signs associated with dangerous causes of back pain include:
●Age less than four years
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- INITIAL MANAGEMENT WHEN SPONDYLOLYSIS IS SUSPECTED
- Ruling out dangerous causes of back pain
- Initial evaluation and observation
- INDICATIONS FOR SPINE SURGERY REFERRAL
- MANAGEMENT OF PATIENTS WITH SPONDYLOLYSIS ESTABLISHED CLINICALLY OR RADIOGRAPHICALLY
- Overview and principles of management
- First follow-up visit for patients with persistent pain
- Treatment by radiograph findings and patient willingness to rest
- Symptom control and basic treatment
- Return to play
- Patients with hypermobility
- Adjunctive treatments
- - Vitamin D
- - Physical therapy
- - Clinic visits and reassessments
- - Surveillance imaging
- PATIENTS WITH PERSISTENT PAIN DESPITE 90-DAYS REST
- PROGNOSIS AND COMPLICATIONS
- SUMMARY AND RECOMMENDATIONS