title: Nonoperative treatment in lumbar spondylolysis and spondylolisthesis: a systematic review.
abstract: BACKGROUND
  Both spondylolysis and spondylolisthesis can be diagnosed across the life span of sports-participating individuals. Determining which treatments are effective for these conditions is imperative to the rehabilitation professional.
  
  
  METHODS
  A computer-assisted literature search was completed in MEDLINE, CINAHL, and EMBASE databases (1966-April 2012) utilizing keywords related to nonoperative treatment of spondylolysis and/or spondylolisthesis. Reference lists were also searched to find all relevant articles that fit our inclusion criteria: English language, human, lumbar pain with diagnosed spondylolysis and/or spondylolisthesis, inclusion of at least 1 nonoperative treatment method, and use of a comparative study design.
  
  
  METHODS
  Data were independently extracted from the selected studies by 2 authors and cross-referenced. Any disagreement on relevant data was discussed and resolved by a third author.
  
  
  RESULTS
  Ten studies meeting the criteria were rated for quality using the GRADE scale. Four studies found surgical intervention more successful than nonoperative treatment for treating pain and functional limitation. One study found no difference between surgery and nonoperative treatment with regard to future low back pain. Improvement was found in bracing, bracing and exercises emphasizing lumbar extension, range of motion and strengthening exercises focusing on lumbar flexion, and strengthening specific abdominal and lumbar muscles.
  
  
  CONCLUSIONS
  No consensus can be reached on the role of nonoperative versus surgical care because of limited investigation and heterogeneity of studies reported. Studies of nonoperative care options suffered from lack of blinding assessors and control groups and decreased patient compliance with exercise programs.
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Matthew
authors.initials: M
authors.lastname: Garet
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Reiman
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Jessie
authors.initials: J
authors.lastname: Mathers
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sylvain
keywords: nonoperative treatment; spondylolisthesis; spondylolysis