Positive Long-Term Outcomes After Nonsurgical Management of Spondylolysis in Adolescents and Young Athletes.

Abstract

Objective: Our study evaluated long-term outcomes of nonoperative treatment of spondylolysis in adolescents and young athletes.

Design: Retrospective case series.

Setting: High-volume sports medicine clinical and research center.

Participants: Spondylolysis patients initially treated nonoperatively (10-25 year old; ≥5 years from diagnosis).

Main outcome measures: We collected self-reported function (Oswestry Disability Index, ODI) and return-to-sport outcomes (for athletes) and compared ODI scores and follow-up between athletes and nonathletes, and between male and female patients.

Results: A total of 150 patients (133 competitive athletes; 108 males; mean age at diagnosis = 16.3 years; mean follow-up time = 8.0 years) were included. Bilateral defects were more common (75%) than unilateral defects (25%), and L5 was the primary affected level (63%). Nonoperative treatment approaches included activity modification (95%), physical therapy (93%), Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) (64%), bracing (38%), and non-NSAID pain medication (23%). The mean ODI score at follow-up was 3.6 (0-100; best score = 0). ODI scores were higher (worse) in female patients versus male patients (P = 0.01), but did not statistically-differ between athletes and nonathletes (P = 0.29). Of competitive athletes, 91% returned to their preinjury sport at the same level or higher. Only 5 patients underwent subsequent back-related surgery after initial nonoperative treatment.

Conclusions: We found excellent long-term outcomes after nonsurgical treatment of spondylolysis in a cohort of adolescents and young adults, including a large proportion of competitive athletes. Our findings underscore that nonsurgical interventions should be the mainstay treatment for spondylolysis in young individuals.