Nonoperative treatment of symptomatic spondylolysis.
BACKGROUND
Symptomatic spondylolysis resulting from a stress fracture of the pars interarticularis is a cause of low back pain in the juvenile and adolescent patient. Treatment is conservative in the majority of cases.


OBJECTIVE
To analyze the outcome of patients with symptomatic isthmic spondylolysis treated nonoperatively with a custom fit thoracolumbar orthosis and activity cessation for 3 months followed by an organized physical therapy program.


METHODS
Retrospective case series.


METHODS
Four hundred thirty-six juvenile and adolescent patients with spondylolysis.


METHODS
Pain improvement, hamstring flexibility, range of motion, resolution of back spasms, and return to previous activities.


METHODS
Retrospective review of 436 juvenile and adolescent patients with symptomatic spondylolysis confirmed by single-photon emission computed tomography or computed tomography. Clinical outcomes were assessed through patient history and physical examination.


RESULTS
Ninety-five percent of patients achieved excellent results according to a modified Odom's Criteria. The remaining 5% of patients achieved good results as they required occasional nonsteroidal anti-inflammatory drugs to relieve pain. Back spasms were resolved and hamstring tightness and range of motion returned to normal in all patients. All patients returned to their preinjury activity level. No patients went on to surgery.


CONCLUSIONS
Symptomatic juvenile and adolescent patients with an isthmus spondylolysis may be effectively managed with a custom fit thoracolumbar orthosis brace and activity cessation for approximately 3 months followed by an organized physical therapy program.
Kurd
Mark F
MF
Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. markkurd@yahoo.com
Patel
Deepan
D
Norton
Robert
R
Picetti
George
G
Friel
Brian
B
Vaccaro
Alexander R
AR
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D015775:Fractures, Stress / Q000150:complications; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae; D008297:Male; D009989:Orthotic Devices; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013169:Spondylolysis / Q000209:etiology / Q000628:therapy*; D013904:Thoracic Vertebrae; D013997:Time Factors