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© 2006 the American Academy of Orthopaedic Surgeons
Spondylolysis and Spondylolisthesis in Children and Adolescents: I. Diagnosis, Natural History, and Nonsurgical Management
Dr. Cavalier is Attending Orthopaedic Surgeon, Summit Sports Medicine and Orthopaedic Surgery, Brunswick, GA. Dr. Herman is Associate Professor, Department of Orthopaedic Surgery, Drexel University College of Medicine, St. Christopher’s Hospital for Children, Philadelphia, PA. Dr. Cheung is Fellow, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN. Dr. Pizzutillo is Professor, Department of Orthopaedic Surgery, Drexel University College of Medicine, St. Christopher’s Hospital for Children.
None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Cavalier, Dr. Herman, Dr. Cheung, and Dr. Pizzutillo.
Reprint requests: Dr. Herman, St. Christopher’s Hospital for Children, Department of Orthopaedic Surgery, Front Street at Erie Avenue, Philadelphia, PA 19134-1095.
Spondylolysis and spondylolisthesis are often diagnosed in children presenting with low back pain. Spondylolysis refers to a defect of the vertebral pars interarticularis. Spondylolisthesis is the forward translation of one vertebral segment over the one beneath it. Isthmic spondylolysis, isthmic spondylolisthesis, and stress reactions involving the pars interarticularis are the most common forms seen in children. Typical presentation is characterized by a history of activity-related low back pain and the presence of painful spinal mobility and hamstring tightness without radiculopathy. Plain radiography, computed tomography, and single-photon emission computed tomography are useful for establishing the diagnosis. Symptomatic stress reactions of the pars interarticularis or adjacent vertebral structures are best treated with immobilization of the spine and activity restriction. Spondylolysis often responds to brief periods of activity restriction, immobilization, and physiotherapy. Low-grade spondylolisthesis (
50% translation) is treated similarly. The less common dysplastic spondylolisthesis with intact posterior elements requires greater caution. Symptomatic high-grade spondylolisthesis (>50% translation) responds much less reliably to nonsurgical treatment. The growing child may need to be followed clinically and radiographically through skeletal maturity. When pain persists despite nonsurgical interventions, when progressive vertebral displacement increases, or in the presence of progressive neurologic deficits, surgical intervention is appropriate.
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