Nonoperative treatment of active spondylolysis in elite athletes with normal X-ray findings: literature review and results of conservative treatment

Sys, J.; Michielsen, Joris; Bracke, P.; Martens, Mark; Verstreken, J

doi:10.1007/s005860100326

Cited by 184 publications

(126 citation statements)

References 34 publications

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“…They stated that their goal was obtain stability by fibrous union of chronic lesions, and not necessarily bone union. Sys et al [12] have reported that 89.3% of athletes managed to return to their same level of competitive activities within an average of 5.5 mo after the start of nonoperative treatment (Boston Overlap Brace). They also have stated that nonunion did not seem to compromise overall outcome or sports resumption in the short-term.…”

Section: Discussionmentioning

confidence: 99%

“…There have been no high level evidence studies that have led to specific recommendations for bracing, rehabilitation, or surgery, and no head to head study has ever proven superiority of treatment methods. To date, the outcomes of conservative or surgical treatment of spondylolysis in athletes have been documented [12][13][14][15][16] . The purpose of the present study was to clarify the efficacy of conservative and surgical treatment of spondylolysis in athletes; especially in terms of their ability to return to sports activities, by reviewing the recent literature.…”

Section: Brief Articlementioning

confidence: 99%

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Return to sports activity by athletes after treatment of spondylolysis

Iwamoto

Satō

Takeda³

et al. 2010

WJO

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Section: Discussionmentioning

confidence: 99%

Section: Brief Articlementioning

confidence: 99%

Return to sports activity by athletes after treatment of spondylolysis

Iwamoto

Satō

Takeda³

et al. 2010

WJO

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“…Increased uptake on SPECT or edema noted on MRI at the injured vertebral level was necessary for the injury to be defined as Conservative care for acute spondylolysis consists of rest from sport, bracing, and physical therapy. 2,6,9,13,16,17,32,40,43,45,46 Young athletes with acute spondylolysis treated with conservative care demonstrate promising short-term clinical outcomes, with 75% to 96% able to make a full return to sport. 9,14,17,25 Studies with long-term clinical outcomes on these patients are limited.…”

Section: Participantsmentioning

confidence: 99%

Long-Term Clinical Outcomes and Factors That Predict Poor Prognosis in Athletes After a Diagnosis of Acute Spondylolysis: A Retrospective Review With Telephone Follow-up

Selhorst¹,

Fischer²,

Graft³

et al. 2016

J Orthop Sports Phys Ther

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® T t STUDY DESIGN:Retrospective review with telephone follow-up. T t BACKGROUND:Acute spondylolytic injuries have a dramatic impact on the young athlete. Excellent short-term clinical outcomes have been observed, but not enough is known about longterm clinical outcomes. T t OBJECTIVES:(1) To report long-term clinical outcomes for patients diagnosed with acute spondylolysis, and (2) to assess the prognostic ability of retrospective variables for long-term outcomes. T t METHODS: Patients from 2010 through 2013were retrospectively reviewed to identify patients and to obtain demographic, baseline, and shortterm outcomes. Long-term follow-up data were collected by telephone from patients diagnosed with acute spondylolysis to assess recurrence rate of low back pain, perceived outcome, pain, and functional ability. Patients were categorized as having a good or poor long-term outcome based on these measures. Logistic regression analysis was performed to assess the prognostic ability of the retrospective variables for long-term outcomes 3.4 years (range, 1.5-5.6 years) after treatment. T t RESULTS:One hundred twenty-one (71.6%) patients completed the follow-up questionnaire (48 female; mean age at baseline, 14.4 years). At follow-up, 81 (66.9%) patients were able to maintain their same or a higher level of sport. Recurrence of significant symptoms was reported by 55 (45.5%) patients, with 41 (33.9%) requiring medical treatment. The final logistic regression model revealed that female sex, adverse reaction during care, and multilevel injury were significant predictors of poor long-term outcome (R 2 = 0.22).

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“…Reported complications include nerve injury, screw protrusion/ backout, screw malpositioning, screw loosening, pseudarthrosis, and iliac crest graft donor-site pain. 10,57,61 Overall, complication rates have been reported to be as high as 40% with the Buck technique, 14% with Scott's wiring, and 44% with Morscher's technique. 4,5,11,27,43,44,60 The authors report no intraoperative complications in the present series.…”

Section: Complicationsmentioning

confidence: 99%

Minimally invasive direct pars repair with cannulated screws and recombinant human bone morphogenetic protein: case series and review of the literature

Ghobrial

Crandall

Lau

et al. 2017

Neurosurgical Focus

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OBJECTIVEThe objective of this study was to describe the use of a minimally invasive surgical treatment of lumbar spondylolysis in athletes by a fluoroscopically guided direct pars screw placement with recombinant human bone morphogenetic protein–2 (rhBMP-2) and to report on clinical and radiographic outcomes.METHODSA retrospective review was conducted of all patients treated surgically for lumbar spondylolysis via a minimally invasive direct pars repair with cannulated screws. Demographic information, clinical features of presentation, perioperative and intraoperative radiographic imaging, and postoperative data were collected. A 1-cm midline incision was performed for the placement of bilateral pars screws utilizing biplanar fluoroscopy, followed by placement of a fully threaded 4.0-mm-diameter titanium cannulated screw. A tubular table-mounted retractor was utilized for direct pars fracture visualization and debridement through a separate incision. The now-visualized pars fracture could then be decorticated, with care taken not to damage the titanium screw when using a high-speed drill. Local bone obtained from the curettage was then placed in the defect with 1.05 mg rhBMP-2 divided equally between the bilateral pars defects.RESULTSNine patients were identified (mean age 17.7 ± 3.42 years, range 14–25 years; 6 male and 3 female). All patients had bilateral pars fractures of L-4 (n = 4) or L-5 (n = 5). The mean duration of preoperative symptoms was 17.22 ± 13.2 months (range 9–48 months). The mean operative duration was 189 ± 29 minutes (range 151–228 minutes). The mean intraoperative blood loss was 17.5 ± 10 ml (range 10–30 ml). Radiographic follow-up was available in all cases; the mean length of time from surgery to the most recent imaging study was 30.8 ± 23.3 months (range 3–59 months). The mean hospital length of stay was 1.13 ± 0.35 days (range 1–2 days). There were no intraoperative complications.CONCLUSIONSLumbar spondylolysis treatment with a minimally invasive direct pars repair is a safe and technically feasible option that minimizes muscle and soft-tissue dissection, which may particularly benefit adolescent patients with a desire to return to a high level of physical activity.

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Nonoperative treatment of active spondylolysis in elite athletes with normal X-ray findings: literature review and results of conservative treatment

Cited by 184 publications

References 34 publications

Return to sports activity by athletes after treatment of spondylolysis

Return to sports activity by athletes after treatment of spondylolysis

Long-Term Clinical Outcomes and Factors That Predict Poor Prognosis in Athletes After a Diagnosis of Acute Spondylolysis: A Retrospective Review With Telephone Follow-up

Minimally invasive direct pars repair with cannulated screws and recombinant human bone morphogenetic protein: case series and review of the literature

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