title: Spondylolysis and spondylolisthesis: a narrative review of etiology, diagnosis, and conservative management.
abstract: OBJECTIVE
  To review current literature regarding the etiology, diagnosis, and conservative treatment of spondylolysis and spondylolytic spondylolisthesis.
  
  
  METHODS
  The PubMed database was searched for articles on spondylolysis and/or spondylolisthesis and their incidence, diagnosis, imaging, treatment, and prognosis. The bibliographies of articles determined to be relevant were also reviewed.
  
  
  RESULTS
  A PubMed search of spondylolysis or spondylolis-thesis yielded over 800 citations. Sixty-eight articles were selected based on an opinion of perceived relevance to the subjects of spondylolysis and spondylolisthesis.
  
  
  CONCLUSIONS
  Spondylolysis affects approximately 6% of the population. The lesion likely represents a stress fracture and the typical age of onset is early childhood and adolescence. Most individuals are asymptomatic. Adolescents with low back pain may have an impending or new pars defect. A high index of suspicion for a new pars defect should prompt utilization of physiologic imaging to determine the likelihood of pars union in young patients. Restrictive bracing may lead to healing of the fracture and cessation of pain. Spondylolisthesis is a common complication of spondylolysis. Spondylolisthesis progression is typically small and most likely in young individuals. Significant progression in adults is rare. The finding of spondylolysis and spondylolisthesis in an adult patient is usually incidental and not likely to be a direct source of pain unless there is concurrent instability.
authors.affiliation: Resident, Department of Radiology, Logan College of Chiropractic, Chesterfield, MO.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Haun
authors.forename: Norman W
authors.initials: NW
authors.lastname: Kettner
references.citation: J Womens Health Gend Based Med. 1999 Jun;8(5):609-15
references.pmid: 10839646
references.citation: AJR Am J Roentgenol. 1999 Sep;173(3):673-6
references.pmid: 10470901
references.citation: Spine (Phila Pa 1976). 1991 Apr;16(4):417-21
references.pmid: 2047915
references.citation: J Pediatr Orthop. 1987 Nov-Dec;7(6):631-8
references.pmid: 2963019
references.citation: Br J Radiol. 1987 Jan;60(709):69-72
references.pmid: 3814997
references.citation: Spine (Phila Pa 1976). 2003 Apr 1;28(7):645-50; discussion 650-1
references.pmid: 12671349
references.citation: Spine (Phila Pa 1976). 1985 Dec;10(10):937-43
references.pmid: 3914087
references.citation: J Bone Joint Surg Br. 1979 Aug;61-B(3):301-5
references.pmid: 383720
references.citation: Spine (Phila Pa 1976). 1997 Dec 15;22(24):2959-67
references.pmid: 9431633
references.citation: J Bone Joint Surg Br. 1995 Sep;77(5):771-3
references.pmid: 7559708
references.citation: Spine (Phila Pa 1976). 2003 May 15;28(10):1027-35; discussion 1035
references.pmid: 12768144
references.citation: Acta Orthop Scand. 1986 Feb;57(1):78-80
references.pmid: 3962638
references.citation: Spine (Phila Pa 1976). 2005 Mar 15;30(6 Suppl):S12-21
references.pmid: 15767879
references.citation: Spine J. 2001 May-Jun;1(3):171-5
references.pmid: 14588344
references.citation: Spine (Phila Pa 1976). 1990 May;15(5):351-5
references.pmid: 2363064
references.citation: Am J Sports Med. 2003 May-Jun;31(3):359-64
references.pmid: 12750127
references.citation: Spine (Phila Pa 1976). 2004 Oct 1;29(19):2168-72
references.pmid: 15454711
references.citation: J Sports Med Phys Fitness. 1978 Dec;18(4):317-40
references.pmid: 745379
references.citation: J Bone Joint Surg Br. 1998 Mar;80(2):208-11
references.pmid: 9546445
references.citation: J Bone Joint Surg Am. 1995 Feb;77(2):190-6
references.pmid: 7844124
references.citation: Spine (Phila Pa 1976). 1991 Apr;16(4):422-5
references.pmid: 2047916
references.citation: J Bone Joint Surg Am. 1971 Apr;53(3):563-6
references.pmid: 5580015
references.citation: Br J Sports Med. 1994 Mar;28(1):56-7
references.pmid: 8044496
references.citation: Acta Radiol. 1988 May-Jun;29(3):345-51
references.pmid: 2968107
references.citation: Clin Orthop Relat Res. 2005 May;(434):46-54
references.pmid: 15864031
references.citation: Radiology. 1984 Dec;153(3):627-9
references.pmid: 6494460
references.citation: Spine (Phila Pa 1976). 2004 Mar 1;29(5):524-7
references.pmid: 15129065
references.citation: Clin Orthop Relat Res. 1989 Sep;(246):86-91
references.pmid: 2670390
references.citation: Spine (Phila Pa 1976). 2002 Jan 15;27(2):141-5
references.pmid: 11805658
references.citation: Arch Phys Med Rehabil. 1993 Sep;74(9):933-9
references.pmid: 8379839
references.citation: Spine (Phila Pa 1976). 2002 Apr 15;27(8):831-8
references.pmid: 11935105
references.citation: Acta Radiol. 1989 Jan-Feb;30(1):65-8
references.pmid: 2914118
references.citation: Spine (Phila Pa 1976). 1984 Sep;9(6):653-5
references.pmid: 6238425
references.citation: Orthopedics. 1991 Apr;14(4):463-5
references.pmid: 2038581
references.citation: Anat Rec. 1951 Feb;109(2):233-52
references.pmid: 14811059
references.citation: Neurosurgery. 1992 Mar;30(3):379-84
references.pmid: 1620301
references.citation: Spine (Phila Pa 1976). 2001 Oct 15;26(20):2208-12; discussion 2212-3
references.pmid: 11598509
references.citation: J Spinal Disord. 1999 Oct;12(5):363-7
references.pmid: 10549697
references.citation: Spine (Phila Pa 1976). 1979 Mar-Apr;4(2):163-7
references.pmid: 264031
references.citation: AJR Am J Roentgenol. 1985 Nov;145(5):1039-44
references.pmid: 2931965
references.citation: Spine (Phila Pa 1976). 1994 Sep 1;19(17):1909-14; discussion 1915
references.pmid: 7997923
references.citation: J Pediatr Orthop. 1991 Mar-Apr;11(2):209-13
references.pmid: 2010523
references.citation: Spine (Phila Pa 1976). 2005 Mar 15;30(6 Suppl):S4-11
references.pmid: 15767885
references.citation: Clin Orthop Relat Res. 1976 Jun;(117):23-9
references.pmid: 1277669
references.citation: Eur Spine J. 2001 Feb;10(1):78-83
references.pmid: 11276840
references.citation: AJNR Am J Neuroradiol. 1995 Aug;16(7):1393-8
references.pmid: 7484621
references.citation: J Bone Miner Res. 2000 Oct;15(10):1992-7
references.pmid: 11028452
references.citation: Acta Orthop Scand. 2000 Jun;71(3):292-6
references.pmid: 10919302
references.citation: Orthopedics. 2004 Jun;27(6):610-3
references.pmid: 15237901
references.citation: Spine (Phila Pa 1976). 1987 Mar;12(2):119-29
references.pmid: 2954216
references.citation: Am J Sports Med. 1986 Sep-Oct;14(5):404-6
references.pmid: 3777317
references.citation: Clin Orthop Relat Res. 1990 Jan;(250):171-5
references.pmid: 2293926
references.citation: Spine (Phila Pa 1976). 1994 Mar 1;19(5):608-12
references.pmid: 8184357
references.citation: Spine (Phila Pa 1976). 1997 Jan 15;22(2):193-7
references.pmid: 9122800
references.citation: J Manipulative Physiol Ther. 1987 Apr;10(2):49-55
references.pmid: 2953840
references.citation: Spine (Phila Pa 1976). 1995 Aug 15;20(16):1761-4
references.pmid: 7502131
references.citation: J Bone Joint Surg Am. 1975 Jan;57(1):17-22
references.pmid: 1123367
references.citation: Scand J Med Sci Sports. 1997 Dec;7(6):322-30
references.pmid: 9458497
references.citation: J Bone Joint Surg Br. 2004 Mar;86(2):225-31
references.pmid: 15046438
references.citation: Clin Pediatr (Phila). 1998 May;37(5):287-93
references.pmid: 9597294
references.citation: Int Orthop. 1999;23(4):213-5
references.pmid: 10591937
references.citation: Scand J Med Sci Sports. 2004 Dec;14(6):346-51
references.pmid: 15546329
references.citation: J Bone Joint Surg Am. 1984 Jun;66(5):699-707
references.pmid: 6373773
references.citation: J Spinal Disord. 1993 Oct;6(5):406-11
references.pmid: 8274809
references.citation: Spine (Phila Pa 1976). 1985 Jul-Aug;10(6):532-42
references.pmid: 4081868