Prevalence and Incidence of Isthmic Spondylolisthesis in Children and Adolescents: A Systematic Review.

Abstract

Background: For children and adolescents active in organized sports, a relationship between spondylolisthesis and low back pain (LBP) has been postulated. Reported prevalence rates vary widely due to inconsistent definitions, populations, and diagnostic methods. Reliable data are needed to inform preventive strategies and clinical decisions, particularly for adolescents engaged in sports.

Purpose: To conduct a systematic review on the prevalence and incidence of radiologically confirmed spondylolisthesis in children and adolescents, considering age, organized sports participation, LBP, and the diagnostic method used.

Study design: Systematic review, Level of evidence, 4.

Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, Scopus, and Web of Science databases were searched by 2 independent reviewers up to August 01, 2025. Original studies reporting cross-sectional or longitudinal data on radiologically confirmed spondylolisthesis in those ≤20 years of age were included. Subgroups were defined by participation in organized sports and LBP: general population (GP/GP-LBP) and individuals active in organized sports (AS/AS-LBP). Descriptive statistics (median [interquartile range, IQR]) were used to analyze subgroups. Correlations between age and prevalence were estimated using the Spearman rank correlation. Study quality was assessed with the Joanna Briggs Institute (JBI) Checklist for Studies Reporting Prevalence Data, and bias was evaluated according to the Cochrane Handbook.

Results: Out of 1566 records, 21 studies (n = 5623; median age 13.1 years [IQR, 11.2-15 years]) were included. The median JBI score was 78% (7 high-, 11 moderate-, 3 low-quality). The pooled prevalence of spondylolisthesis in childhood and adolescence was 3.4% [IQR, 1.9%-4.9%]. Subgroup analyses showed higher prevalence in AS (median, 4.5% [IQR, 4.2%-5.2%]) and AS-LBP (5.3%) compared with GP (median, 2.3% [IQR, 0.5%-2.7%]) and GP-LBP (median, 3.8% [IQR, 2.3%-5.2%]). A positive correlation with age was observed for the AS group (P = .61). Incidence was reported in only 1 study. Magnetic resonance imaging-based studies reported higher prevalence estimates than computed tomography- or radiography-based studies in descriptive comparisons.

Conclusion: Our study demonstrates that the prevalence of spondylolisthesis increases with age, participation in organized sports, and LBP, indicating a significant number of acquired cases during adolescence. Reported prevalence rates vary depending on the diagnostic method used. Incidence remains insufficiently characterized, underscoring the need for standardized longitudinal research improving evidence on the development of isthmic spondylolisthesis. These findings suggest that repetitive mechanical loading of the pars interarticularis may represent a key underlying mechanism.