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. 2000 Dec;34(6):415–422. doi: 10.1136/bjsm.34.6.415

Spondylolysis: a critical review

C Standaert 1, S Herring 1
PMCID: PMC1724260  PMID: 11131228

Abstract

Aim—To provide an understanding of the current concepts in the natural history, pathophysiology, diagnosis, and treatment of spondylolysis based on the available medical literature.

Methods—Articles were selected for review by the following methods: (a) MEDLINE searches with review of abstracts to select relevant articles; (b) review of multiple textbooks considered likely to contain information on spondylolysis; (c) review of references in articles identified by (a) and (b). Over 125 articles were ultimately reviewed fully. Publications were selected for inclusion in this article on the basis of perceived scientific and historical merit, particularly as thought to be relevant to achieving the stated purpose of this review. As no controlled clinical trials were identified, this could not be used as an inclusion criterion.

Conclusions—Isthmic spondylolysis is considered to represent a fatigue fracture of the pars interarticularis of the neural arch. There is a relatively high incidence of radiographically identified spondylolysis in the general population, but the vast majority of these lesions probably occur without associated symptoms. Symptomatic pars lesions appear to be particularly a clinical problem in adolescents, especially adolescent athletes. The optimal diagnostic and treatment algorithms are not well identified in the current literature. Multiple imaging studies may have a role in the diagnosis of a pars lesion, and treatment seems likely to require at least relative rest and physical rehabilitation with consideration of bracing or, rarely, surgical intervention depending on the clinical context.

Key Words: spondylolysis; spondylolisthesis; spine; back; neural arch; pars interarticularis

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Selected References

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  1. Amato M., Totty W. G., Gilula L. A. Spondylolysis of the lumbar spine: demonstration of defects and laminal fragmentation. Radiology. 1984 Dec;153(3):627–629. doi: 10.1148/radiology.153.3.6494460. [DOI] [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. Blackburne J. S., Velikas E. P. Spondylolisthesis in children and adolescents. J Bone Joint Surg Br. 1977 Nov;59-B(4):490–494. doi: 10.1302/0301-620X.59B4.925059. [DOI] [PubMed] [Google Scholar]
  4. Blanda J., Bethem D., Moats W., Lew M. Defects of pars interarticularis in athletes: a protocol for nonoperative treatment. J Spinal Disord. 1993 Oct;6(5):406–411. doi: 10.1097/00002517-199306050-00007. [DOI] [PubMed] [Google Scholar]
  5. Bodner R. J., Heyman S., Drummond D. S., Gregg J. R. The use of single photon emission computed tomography (SPECT) in the diagnosis of low-back pain in young patients. Spine (Phila Pa 1976) 1988 Oct;13(10):1155–1160. doi: 10.1097/00007632-198810000-00018. [DOI] [PubMed] [Google Scholar]
  6. Campbell R. S., Grainger A. J. Optimization of MRI pulse sequences to visualize the normal pars interarticularis. Clin Radiol. 1999 Jan;54(1):63–68. doi: 10.1016/s0009-9260(99)91242-4. [DOI] [PubMed] [Google Scholar]
  7. Ciullo J. V., Jackson D. W. Pars interarticularis stress reaction, spondylolysis, and spondylolisthesis in gymnasts. Clin Sports Med. 1985 Jan;4(1):95–110. [PubMed] [Google Scholar]
  8. Collier B. D., Johnson R. P., Carrera G. F., Meyer G. A., Schwab J. P., Flatley T. J., Isitman A. T., Hellman R. S., Zielonka J. S., Knobel J. Painful spondylolysis or spondylolisthesis studied by radiography and single-photon emission computed tomography. Radiology. 1985 Jan;154(1):207–211. doi: 10.1148/radiology.154.1.3155479. [DOI] [PubMed] [Google Scholar]
  9. Congeni J., McCulloch J., Swanson K. Lumbar spondylolysis. A study of natural progression in athletes. Am J Sports Med. 1997 Mar-Apr;25(2):248–253. doi: 10.1177/036354659702500220. [DOI] [PubMed] [Google Scholar]
  10. Cyron B. M., Hutton W. C. The fatigue strength of the lumbar neural arch in spondylolysis. J Bone Joint Surg Br. 1978 May;60-B(2):234–238. doi: 10.1302/0301-620X.60B2.659472. [DOI] [PubMed] [Google Scholar]
  11. Cyron B. M., Hutton W. C. Variations in the amount and distribution of cortical bone across the partes interarticulares of L5. A predisposing factor in spondylolysis? Spine (Phila Pa 1976) 1979 Mar-Apr;4(2):163–167. doi: 10.1097/00007632-197903000-00013. [DOI] [PubMed] [Google Scholar]
  12. Daniel J. N., Polly D. W., Jr, Van Dam B. E. A study of the efficacy of nonoperative treatment of presumed traumatic spondylolysis in a young patient population. Mil Med. 1995 Nov;160(11):553–555. [PubMed] [Google Scholar]
  13. Danielson B. I., Frennered A. K., Irstam L. K. Radiologic progression of isthmic lumbar spondylolisthesis in young patients. Spine (Phila Pa 1976) 1991 Apr;16(4):422–425. doi: 10.1097/00007632-199104000-00005. [DOI] [PubMed] [Google Scholar]
  14. Dietrich M., Kurowski P. The importance of mechanical factors in the etiology of spondylolysis. A model analysis of loads and stresses in human lumbar spine. Spine (Phila Pa 1976) 1985 Jul-Aug;10(6):532–542. doi: 10.1097/00007632-198507000-00007. [DOI] [PubMed] [Google Scholar]
  15. Elliott S., Hutson M. A., Wastie M. L. Bone scintigraphy in the assessment of spondylolysis in patients attending a sports injury clinic. Clin Radiol. 1988 May;39(3):269–272. doi: 10.1016/s0009-9260(88)80528-2. [DOI] [PubMed] [Google Scholar]
  16. 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]
  17. Fellander-Tsai L., Micheli L. J. Treatment of spondylolysis with external electrical stimulation and bracing in adolescent athletes: a report of two cases. Clin J Sport Med. 1998 Jul;8(3):232–234. doi: 10.1097/00042752-199807000-00012. [DOI] [PubMed] [Google Scholar]
  18. Fredrickson B. E., Baker D., McHolick W. J., Yuan H. A., Lubicky J. P. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. 1984 Jun;66(5):699–707. [PubMed] [Google Scholar]
  19. Frennered A. K., Danielson B. I., Nachemson A. L. Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study. J Pediatr Orthop. 1991 Mar-Apr;11(2):209–213. doi: 10.1097/01241398-199103000-00014. [DOI] [PubMed] [Google Scholar]
  20. Gerbino P. G., 2nd, Micheli L. J. Back injuries in the young athlete. Clin Sports Med. 1995 Jul;14(3):571–590. [PubMed] [Google Scholar]
  21. Goldstein J. D., Berger P. E., Windler G. E., Jackson D. W. Spine injuries in gymnasts and swimmers. An epidemiologic investigation. Am J Sports Med. 1991 Sep-Oct;19(5):463–468. doi: 10.1177/036354659101900507. [DOI] [PubMed] [Google Scholar]
  22. Harvey C. J., Richenberg J. L., Saifuddin A., Wolman R. L. The radiological investigation of lumbar spondylolysis. Clin Radiol. 1998 Oct;53(10):723–728. doi: 10.1016/s0009-9260(98)80313-9. [DOI] [PubMed] [Google Scholar]
  23. 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]
  24. 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]
  25. Letts M., Smallman T., Afanasiev R., Gouw G. Fracture of the pars interarticularis in adolescent athletes: a clinical-biomechanical analysis. J Pediatr Orthop. 1986 Jan-Feb;6(1):40–46. doi: 10.1097/01241398-198601000-00009. [DOI] [PubMed] [Google Scholar]
  26. Libson E., Bloom R. A., Dinari G. Symptomatic and asymptomatic spondylolysis and spondylolisthesis in young adults. Int Orthop. 1982;6(4):259–261. doi: 10.1007/BF00267148. [DOI] [PubMed] [Google Scholar]
  27. 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]
  28. Lowe J., Schachner E., Hirschberg E., Shapiro Y., Libson E. Significance of bone scintigraphy in symptomatic spondylolysis. Spine (Phila Pa 1976) 1984 Sep;9(6):653–655. doi: 10.1097/00007632-198409000-00019. [DOI] [PubMed] [Google Scholar]
  29. Lusins J. O., Elting J. J., Cicoria A. D., Goldsmith S. J. SPECT evaluation of lumbar spondylolysis and spondylolisthesis. Spine (Phila Pa 1976) 1994 Mar 1;19(5):608–612. doi: 10.1097/00007632-199403000-00018. [DOI] [PubMed] [Google Scholar]
  30. 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]
  31. Micheli L. J. Back injuries in gymnastics. Clin Sports Med. 1985 Jan;4(1):85–93. [PubMed] [Google Scholar]
  32. 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]
  33. Morita T., Ikata T., Katoh S., Miyake R. Lumbar spondylolysis in children and adolescents. J Bone Joint Surg Br. 1995 Jul;77(4):620–625. [PubMed] [Google Scholar]
  34. 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]
  35. O'Neill D. B., Micheli L. J. Postoperative radiographic evidence for fatigue fracture as the etiology in spondylolysis. Spine (Phila Pa 1976) 1989 Dec;14(12):1342–1355. doi: 10.1097/00007632-198912000-00011. [DOI] [PubMed] [Google Scholar]
  36. ROCHE M. B., ROWE G. G. The incidence of separate neural arch and coincident bone variations; a survey of 4,200 skeletons. Anat Rec. 1951 Feb;109(2):233–252. doi: 10.1002/ar.1091090207. [DOI] [PubMed] [Google Scholar]
  37. Raby N., Mathews S. Symptomatic spondylolysis: correlation of CT and SPECT with clinical outcome. Clin Radiol. 1993 Aug;48(2):97–99. doi: 10.1016/s0009-9260(05)81080-3. [DOI] [PubMed] [Google Scholar]
  38. Rosenberg N. J., Bargar W. L., Friedman B. The incidence of spondylolysis and spondylolisthesis in nonambulatory patients. Spine (Phila Pa 1976) 1981 Jan-Feb;6(1):35–38. doi: 10.1097/00007632-198101000-00005. [DOI] [PubMed] [Google Scholar]
  39. Rossi F. Spondylolysis, spondylolisthesis and sports. J Sports Med Phys Fitness. 1978 Dec;18(4):317–340. [PubMed] [Google Scholar]
  40. Sagi H. C., Jarvis J. G., Uhthoff H. K. Histomorphic analysis of the development of the pars interarticularis and its association with isthmic spondylolysis. Spine (Phila Pa 1976) 1998 Aug 1;23(15):1635–1640. doi: 10.1097/00007632-199808010-00002. [DOI] [PubMed] [Google Scholar]
  41. Saifuddin A., White J., Tucker S., Taylor B. A. Orientation of lumbar pars defects: implications for radiological detection and surgical management. J Bone Joint Surg Br. 1998 Mar;80(2):208–211. doi: 10.1302/0301-620x.80b2.8219. [DOI] [PubMed] [Google Scholar]
  42. Saraste H. Long-term clinical and radiological follow-up of spondylolysis and spondylolisthesis. J Pediatr Orthop. 1987 Nov-Dec;7(6):631–638. [PubMed] [Google Scholar]
  43. Seitsalo S., Osterman K., Hyvãrinen H., Tallroth K., Schlenzka D., Poussa M. Progression of spondylolisthesis in children and adolescents. A long-term follow-up of 272 patients. Spine (Phila Pa 1976) 1991 Apr;16(4):417–421. doi: 10.1097/00007632-199104000-00004. [DOI] [PubMed] [Google Scholar]
  44. Semon R. L., Spengler D. Significance of lumbar spondylolysis in college football players. Spine (Phila Pa 1976) 1981 Mar-Apr;6(2):172–174. doi: 10.1097/00007632-198103000-00012. [DOI] [PubMed] [Google Scholar]
  45. Soler T., Calderón C. The prevalence of spondylolysis in the Spanish elite athlete. Am J Sports Med. 2000 Jan-Feb;28(1):57–62. doi: 10.1177/03635465000280012101. [DOI] [PubMed] [Google Scholar]
  46. Steiner M. E., Micheli L. J. Treatment of symptomatic spondylolysis and spondylolisthesis with the modified Boston brace. Spine (Phila Pa 1976) 1985 Dec;10(10):937–943. doi: 10.1097/00007632-198512000-00013. [DOI] [PubMed] [Google Scholar]
  47. Stinson J. T. Spondylolysis and spondylolisthesis in the athlete. Clin Sports Med. 1993 Jul;12(3):517–528. [PubMed] [Google Scholar]
  48. Teplick J. G., Laffey P. A., Berman A., Haskin M. E. Diagnosis and evaluation of spondylolisthesis and/or spondylolysis on axial CT. AJNR Am J Neuroradiol. 1986 May-Jun;7(3):479–491. [PMC free article] [PubMed] [Google Scholar]
  49. Turner R. H., Bianco A. J., Jr Spondylolysis and spondylolisthesis in children and teen-agers. J Bone Joint Surg Am. 1971 Oct;53(7):1298–1306. [PubMed] [Google Scholar]
  50. Udeshi U. L., Reeves D. Routine thin slice MRI effectively demonstrates the lumbar pars interarticularis. Clin Radiol. 1999 Sep;54(9):615–619. doi: 10.1016/s0009-9260(99)90024-7. [DOI] [PubMed] [Google Scholar]
  51. 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]
  52. 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]
  53. Yamane T., Yoshida T., Mimatsu K. Early diagnosis of lumbar spondylolysis by MRI. J Bone Joint Surg Br. 1993 Sep;75(5):764–768. doi: 10.1302/0301-620X.75B5.8376435. [DOI] [PubMed] [Google Scholar]

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