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Journal of Athletic Training logoLink to Journal of Athletic Training
. 1998 Oct-Dec;33(4):351–358.

The Pars Interarticularis Stress Reaction, Spondylolysis, and Spondylolisthesis Progression

Gina Motley *, John Nyland , Jake Jacobs , David N M Caborn
PMCID: PMC1320587  PMID: 16558534

Abstract

Objective:

To review the classification, etiology, clinical and radiologic evaluation, and management of the pars interarticularis stress reaction, spondylolysis, and spondylolisthesis progression.

Data Sources:

Grateful Med was searched from 1980 to 1998 using the terms “spondylolysis,” “spondylolisthesis,” “female athlete” “spondylogenic,” and “pars interarticularis.”

Data Synthesis:

The progression from pars interarticularis stress reaction through spondylolysis to spondylolisthesis is common in adolescent athletes, and, because of hormonal influences and cheerleading and gymnastic maneuvers, females are particularly at risk. Proper diagnosis and management include a thorough evaluation, radiographs (possibly with technetium bone scan or single-photon emission computed tomography), activity modification, dietary counseling, a therapeutic exercise program focusing on proper trunk and hip muscle strength and extensibility balances, and education regarding proper back postures, positioning, lifting mechanics, and jump landings.

Conclusions/Recommendations:

The athletic trainer plays an integral part in managing this injury progression, particularly with identifying at-risk individuals and intervening appropriately.

Keywords: low back pain, female athlete, lumbar vertebra

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Selected References

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  1. Bell D. F., Ehrlich M. G., Zaleske D. J. Brace treatment for symptomatic spondylolisthesis. Clin Orthop Relat Res. 1988 Nov;(236):192–198. [PubMed] [Google Scholar]
  2. Bellah R. D., Summerville D. A., Treves S. T., Micheli L. J. Low-back pain in adolescent athletes: detection of stress injury to the pars interarticularis with SPECT. Radiology. 1991 Aug;180(2):509–512. doi: 10.1148/radiology.180.2.1829845. [DOI] [PubMed] [Google Scholar]
  3. Cantu R. C. Head and spine injuries in the young athlete. Clin Sports Med. 1988 Jul;7(3):459–472. [PubMed] [Google Scholar]
  4. Commandre F. A., Taillan B., Gagnerie F., Zakarian H., Lescourgues M., Fourre J. M. Spondylolysis and spondylolisthesis in young athletes: 28 cases. J Sports Med Phys Fitness. 1988 Mar;28(1):104–107. [PubMed] [Google Scholar]
  5. Daltroy L. H., Iversen M. D., Larson M. G., Lew R., Wright E., Ryan J., Zwerling C., Fossel A. H., Liang M. H. A controlled trial of an educational program to prevent low back injuries. N Engl J Med. 1997 Jul 31;337(5):322–328. doi: 10.1056/NEJM199707313370507. [DOI] [PubMed] [Google Scholar]
  6. Farfan H. F., Osteria V., Lamy C. The mechanical etiology of spondylolysis and spondylolisthesis. Clin Orthop Relat Res. 1976 Jun;(117):40–55. [PubMed] [Google Scholar]
  7. Fruth S. J., Worrell T. W. Factors associated with menstrual irregularities and decreased bone mineral density in female athletes. J Orthop Sports Phys Ther. 1995 Jul;22(1):26–38. doi: 10.2519/jospt.1995.22.1.26. [DOI] [PubMed] [Google Scholar]
  8. Garrick J. G., Requa R. K. Epidemiology of women's gymnastics injuries. Am J Sports Med. 1980 Jul-Aug;8(4):261–264. doi: 10.1177/036354658000800409. [DOI] [PubMed] [Google Scholar]
  9. Ginsburg GM, Bassett GS. Back Pain in Children and Adolescents: Evaluation and Differential Diagnosis. J Am Acad Orthop Surg. 1997 Mar;5(2):67–78. doi: 10.5435/00124635-199703000-00002. [DOI] [PubMed] [Google Scholar]
  10. Harvey J., Tanner S. Low back pain in young athletes. A practical approach. Sports Med. 1991 Dec;12(6):394–406. doi: 10.2165/00007256-199112060-00005. [DOI] [PubMed] [Google Scholar]
  11. Hewett T. E., Stroupe A. L., Nance T. A., Noyes F. R. Plyometric training in female athletes. Decreased impact forces and increased hamstring torques. Am J Sports Med. 1996 Nov-Dec;24(6):765–773. doi: 10.1177/036354659602400611. [DOI] [PubMed] [Google Scholar]
  12. Ikata T., Miyake R., Katoh S., Morita T., Murase M. Pathogenesis of sports-related spondylolisthesis in adolescents. Radiographic and magnetic resonance imaging study. Am J Sports Med. 1996 Jan-Feb;24(1):94–98. doi: 10.1177/036354659602400117. [DOI] [PubMed] [Google Scholar]
  13. Jackson D. W., Wiltse L. L., Cirincoine R. J. Spondylolysis in the female gymnast. Clin Orthop Relat Res. 1976 Jun;(117):68–73. [PubMed] [Google Scholar]
  14. Jackson D. W., Wiltse L. L., Dingeman R. D., Hayes M. Stress reactions involving the pars interarticularis in young athletes. Am J Sports Med. 1981 Sep-Oct;9(5):304–312. doi: 10.1177/036354658100900504. [DOI] [PubMed] [Google Scholar]
  15. Jonnavithula S., Warren M. P., Fox R. P., Lazaro M. I. Bone density is compromised in amenorrheic women despite return of menses: a 2-year study. Obstet Gynecol. 1993 May;81(5 ):669–674. [PubMed] [Google Scholar]
  16. Kakiuchi M. Repair of the defect in spondylolysis. Durable fixation with pedicle screws and laminar hooks. J Bone Joint Surg Am. 1997 Jun;79(6):818–825. doi: 10.2106/00004623-199706000-00003. [DOI] [PubMed] [Google Scholar]
  17. Lindholm T. S., Ragni P., Ylikoski M., Poussa M. Lumbar isthmic spondylolisthesis in children and adolescents. Radiologic evaluation and results of operative treatment. Spine (Phila Pa 1976) 1990 Dec;15(12):1350–1355. doi: 10.1097/00007632-199012000-00021. [DOI] [PubMed] [Google Scholar]
  18. Magora A. Conservative treatment in spondylolisthesis. Clin Orthop Relat Res. 1976 Jun;(117):74–79. [PubMed] [Google Scholar]
  19. McCarroll J. R., Miller J. M., Ritter M. A. Lumbar spondylolysis and spondylolisthesis in college football players. A prospective study. Am J Sports Med. 1986 Sep-Oct;14(5):404–406. doi: 10.1177/036354658601400513. [DOI] [PubMed] [Google Scholar]
  20. Micheli L. J. Back injuries in gymnastics. Clin Sports Med. 1985 Jan;4(1):85–93. [PubMed] [Google Scholar]
  21. Micheli L. J., Wood R. Back pain in young athletes. Significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med. 1995 Jan;149(1):15–18. doi: 10.1001/archpedi.1995.02170130017004. [DOI] [PubMed] [Google Scholar]
  22. Muschik M., Hähnel H., Robinson P. N., Perka C., Muschik C. Competitive sports and the progression of spondylolisthesis. J Pediatr Orthop. 1996 May-Jun;16(3):364–369. doi: 10.1097/00004694-199605000-00014. [DOI] [PubMed] [Google Scholar]
  23. Olsen T. L., Anderson R. L., Dearwater S. R., Kriska A. M., Cauley J. A., Aaron D. J., LaPorte R. E. The epidemiology of low back pain in an adolescent population. Am J Public Health. 1992 Apr;82(4):606–608. doi: 10.2105/ajph.82.4.606. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Pizzutillo P. D., Hummer C. D., 3rd Nonoperative treatment for painful adolescent spondylolysis or spondylolisthesis. J Pediatr Orthop. 1989 Sep-Oct;9(5):538–540. doi: 10.1097/01241398-198909010-00007. [DOI] [PubMed] [Google Scholar]
  25. Recknagel S., Witte H. Landung nach Sprüngen--falsche Technik begünstigt die Spondylolyse. Z Orthop Ihre Grenzgeb. 1996 May-Jun;134(3):214–218. doi: 10.1055/s-2008-1039751. [DOI] [PubMed] [Google Scholar]
  26. Sinaki M., Lutness M. P., Ilstrup D. M., Chu C. P., Gramse R. R. Lumbar spondylolisthesis: retrospective comparison and three-year follow-up of two conservative treatment programs. Arch Phys Med Rehabil. 1989 Aug;70(8):594–598. [PubMed] [Google Scholar]
  27. Wiltse L. L., Newman P. H., Macnab I. Classification of spondylolisis and spondylolisthesis. Clin Orthop Relat Res. 1976 Jun;(117):23–29. [PubMed] [Google Scholar]
  28. Wiltse L. L., Widell E. H., Jr, Jackson D. W. Fatigue fracture: the basic lesion is inthmic spondylolisthesis. J Bone Joint Surg Am. 1975 Jan;57(1):17–22. [PubMed] [Google Scholar]

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