The natural history of spondylolysis and spondylolisthesis: 45-year follow-up evaluation.
METHODS
A prospective study of spondylolysis and spondylolisthesis was initiated in 1955 with a radiographic and clinical study of 500 first-grade children.


OBJECTIVE
To determine the natural history of spondylolysis and spondylolisthesis.


BACKGROUND
Most studies on the natural history of spondylolysis and spondylolisthesis are based on patient populations presenting with pain. Critical to any natural history investigation is the study of a population of affected individuals, whether symptomatic or not, from onset of the condition through their lives.


METHODS
By study of a population from the age of 6 years to adulthood, 30 individuals were identified to have pars lesions. Data collection at a 45-year follow-up assessment included magnetic resonance imaging, a back pain questionnaire, and the SF-36 Survey.


RESULTS
No subject with a pars defect was lost to follow-up evaluation once a lesion was identified. Subjects with unilateral defects never experienced slippage over the course of the study. Progression of spondylolisthesis slowed with each decade. There was no association of slip progression and low back pain. There was no statistically significant difference between the study population SF-36 scores and those of the general population the same age.


CONCLUSIONS
This report is the only prospective study to document the natural history of spondylolysis and spondylolisthesis from onset through more than 45 years of life in a population unselected for pain. Subjects with pars defects follow a clinical course similar to that of the general population. There appears to be a marked slowing of slip progression with each decade, and no subject has reached a 40% slip.
Beutler
William J
WJ
State University of New York Upstate Medical University, Syracuse, New York, USA.
Fredrickson
Bruce E
BE
Murtland
Albert
A
Sweeney
Colleen A
CA
Grant
William D
WD
Baker
Daniel
D
D000293:Adolescent; D000328:Adult; D002648:Child; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D013168:Spondylolisthesis / Q000473:pathology*; D013169:Spondylolysis / Q000473:pathology*; D011795:Surveys and Questionnaires; D013997:Time Factors