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Spondylolysis 2019 update

Berger, Rachel G.; Doyle, Shevaun M.

doi: 10.1097/MOP.0000000000000706
ORTHOPEDICS: Edited by Daniel W. Green

Purpose of review Provide a comprehensive overview of lumbar spondylolysis, a frequent cause of lower back pain in children and adolescents, from evaluation to management.

Recent findings With the surge of structured sports participation in the pediatric population, spondylolysis is a common ailment that afflicts many young athletes due to rigorous competition that taxes the growing spine with repetitive extension and rotation.

Summary Spondylolysis is a fracture through the pars interarticularis. When a child presents with lower back pain, spondylolysis should be at the top of the differential. A thorough history and physical examination are essential. In addition, radiographs of the lumbar spine, anterior posterior and lateral views, MRI and, selectively, computed tomography are useful adjuncts to uncover a pars injury. Timely diagnosis facilitates early treatment which includes rest, optimizing bone health, brace treatment, and physical therapy. If delayed or untreated, spondylolysis may result in nonunion or pars defect. If symptomatic, patients may need surgery to fuse the lumbar facet joints or repair the par interarticularis.

Washington University in St. Louis, St. Louis, Missouri, USA

Correspondence to Shevaun M. Doyle, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. Tel: +1 646 797 8816; e-mail:

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