Rehabilitation Considerations for Spondylolysis in the Youth Athlete

Selhorst, Mitchell; Allen, Michael; McHugh, Robyn; MacDonald, James

doi:10.26603/ijspt20200287

Cited by 12 publications

(15 citation statements)

References 84 publications

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“…Spondylolisthesis is a stress injury, which can be found in patients with chronic low back pain (CLBP) and radicular pain during the clinical assessment. 1,2 Spondylolisthesis is known as an anatomical defect, commonly seen in the lower lumbar vertebrae. 1,2 It is the anterior displacement of one vertebra relative to the subjacent vertebra.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Study between Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion for Treatment of Spondylolisthesis: Clinical Outcomes and Spino-Pelvic Sagittal Balance Parameters

Farrokhi

Eghbal

Mousavi

et al. 2021

Indian Journal of Neurotrauma

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Objective This retrospective study aims to compare the clinical and radiological outcomes of posterolateral fusion (PLF) with transforaminal lumbar interbody fusion (TLIF + PLF) for the treatment of patients with low-grade spondylolisthesis. Methodology A total of 77 adult patients ≥18 years with low-grade spondylolisthesis, Meyerding grades I and II, were assigned into two groups: 36 patients treated with PLF and 41 patients treated with TLIF + PLF. The PLF group is composed of the patients that were operated with pedicle screw and the TLIF + PLF group is composed of the ones that were operated with fixation and TILF by autografting. Clinical evaluation was performed using the spino-pelvic sagittal balance, Numeric Rating Scale, Oswestry Disability Index, blood loss, operation times, and postoperative hospital stay of the PLF vs TLIF groups. The incidences of postoperative low back pain and radicular pain in the two groups were also recorded. Radiography was performed preoperatively and postoperatively to assess spino-pelvic parameters. Results Significant restoration of spino-pelvic sagittal balance was observed in the TLIF group after surgery, and all spino-pelvic sagittal balance parameters showed significant improvement in the TLIF group after surgery, while in the PLF group, all spino-pelvic sagittal parameters had improved except the segmental angle lordosis (p = 0.316), which showed no significant difference after surgery in the PLF group. Postoperative pelvic incidence and pelvic tilt significantly improved in the TLIF group in comparison to PLF groups. Hence, TLIF can achieve better postoperative spino-pelvic sagittal balance parameters than PLF. There was no difference in the complication rates for each group. Both groups achieved significant improvement in postoperative clinical outcomes, and there was no significant difference in the incidence of postoperative low back pain or radicular pain between the two groups. Conclusion Both surgical procedures PLF and TLIF were effective. PLF and TLIF can result in improved clinical and radiological outcomes for patients treated for low-grade spondylolisthesis. TLIF can achieve better restoration of spino-pelvic sagittal balance parameters than PLF alone.

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Section: Introductionmentioning

confidence: 99%

“…1,2 Spondylolisthesis is known as an anatomical defect, commonly seen in the lower lumbar vertebrae. 1,2 It is the anterior displacement of one vertebra relative to the subjacent vertebra. This defect mostly happens at levels L4-L5 and L5-S1.…”

Section: Introductionmentioning

confidence: 99%

Comparative Study between Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion for Treatment of Spondylolisthesis: Clinical Outcomes and Spino-Pelvic Sagittal Balance Parameters

Farrokhi

Eghbal

Mousavi

et al. 2021

Indian Journal of Neurotrauma

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“…Lumbar bracing may be used, however, should be saved for patients who fail to improve without bracing, as there is controversy regarding the impact of bracing on clinical outcomes and concern that the restriction may increase movement at the lumbosacral junction. [31][32][33] Several primary articles support early initiation of physical therapy as opposed to long periods of immobilization, which allows earlier return to sport, possibly due to minimizing muscle atrophy and deconditioning. [32][33][34][35][36][37] Physical therapy should be guided towards strengthening deep abdominals and multifidus muscles in conjunction with sport-specific exercises.…”

Section: Conservative Treatmentmentioning

confidence: 99%

“…[31][32][33] Several primary articles support early initiation of physical therapy as opposed to long periods of immobilization, which allows earlier return to sport, possibly due to minimizing muscle atrophy and deconditioning. [32][33][34][35][36][37] Physical therapy should be guided towards strengthening deep abdominals and multifidus muscles in conjunction with sport-specific exercises. Dynamic weightbearing exercises can also be used in later stages of therapy.…”

Section: Conservative Treatmentmentioning

confidence: 99%

“…Dynamic weightbearing exercises can also be used in later stages of therapy. [31][32][33] Hamstring tightness has been correlated to low back pain in certain sports disciplines, however, research regarding addressing hamstring tightness in treating low back pain and the integration of this into physical therapy protocols is required. 38 The results of conservative treatment are generally excellent.…”

Section: Conservative Treatmentmentioning

confidence: 99%

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Back pain in adolescent athletes: a narrative review

et al. 2022

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Background Back pain in young athletes is common. Adolescents are at an increased risk for back pain related to several factors including rapid growth. Traditionally, the conversation around back pain in the adolescent age group has been centered around diagnosis and treatment; however, there are emerging studies regarding prevention. Objective The purpose of the present investigation is to summarize sport-specific risk factors, to describe the growing emphasis on prevention/screening, and report results on minimally invasive and surgical options. Methods The literature search was performed in Mendeley. Search fields were varied until redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. The full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by at least 3 authors until an agreement was reached. Results Adolescent athletes have a higher risk of developing spondylolysis and spondylolisthesis than their non-athletic counterparts. Participation in athletic activity alone, increased body mass index, varsity status, and nationally/internationally competitive status are identified are demographic risk factors. Weightlifters, gymnasts, football players, and combat athletes may be at higher risks. Increased lumbar lordosis, abdominal muscle weakness, hip flexor tightness, hamstring tightness, thoracolumbar fascia tightness, femoral anteversion, genu recurvatum, and thoracic kyphosis also predispose. Recent cadaveric and kinematic studies have furthered our understanding of pathoanatomic. There is some evidence to suggest that isokinetic testing and electromyographic data may be able to identify at-risk individuals. Perturbation-based exercise interventions can reduce the incidence of adolescent athletic back pain. There is a large body of evidence to support the efficacy of physical therapy. There is some data to support minimally invasive treatments including external bone growth simulators, steroid injections, and chemonucleolysis for specific pathologies. Endoscopic surgery results for a limited subset of patients with certain disease processes are good. Conclusions Back pain in adolescent athletes is common and may not lead to appropriate alterations in athletes’ level of participation. Athletes with a higher body mass index should be counseled regarding the benefits of losing weight. Isokinetic testing and electromyographic data have the potential as diagnostic and screening tools. Strength deficits and postural control could be used to identify patients requiring early intervention and thus reduce the incidence. External bone growth simulators, steroid injections, and chemonucleolysis could potentially become conservative options in the future. When surgery is indicated, the endoscopic intervention has the potential to decrease operative time, decrease cost, and promote healing.

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