title: Athletic Population with Spondylolysis: Review of Outcomes following Surgical Repair or Conservative Management.
abstract: METHODS
  Narrative review.
  
  
  OBJECTIVE
  The study aims to critically review the outcomes associated with the surgical repair or conservative management of spondylolysis in athletes.
  
  
  METHODS
  The English literature listed in MEDLINE/PubMed was reviewed to identify related articles using the term "spondylolysis AND athlete." The criteria for studies to be included were management of spondylolysis in athletes, English text, and no year, follow-up, or study design restrictions. The references of the retrieved articles were also evaluated. The primary outcome was time to return to sport. This search yielded 180 citations, and 25 publications were included in the review.
  
  
  RESULTS
  Treatment methods were dichotomized as operative and nonoperative. In the nonoperative group, 390 athletes were included. A combination of bracing with physical therapy and restriction of activities was used. Conservative measures allowed athletes to return to sport in 3.7 months (weighted mean). One hundred seventy-four patients were treated surgically. The most common technique was Buck's, using a compression screw (91/174). All authors reported satisfactory outcomes. Time to return to play was 7.9 months (weighted mean). There were insufficient studies with suitably homogenous subgroups to conduct a meta-analysis.
  
  
  CONCLUSIONS
  There is no gold standard approach for the management of spondylolysis in the athletic population. The existing literature suggests initial therapy should be a course of conservative management with thoracolumbosacral orthosis brace, physiotherapy, and activity modification. If conservative management fails, surgical intervention should be considered. Two-sided clinical studies are needed to determine an optimal pathway for the management of athletes with spondylolysis.
authors.affiliation: Spinal Department, Oxford University Hospitals, Headley Way, Oxford, United Kingdom.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Panteliadis
authors.affiliation: Orthopaedic Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, United Kingdom; Division of Medical Sciences, Oxford University Clinical Academic Graduate School, Headley Way, Oxford, United Kingdom.
authors.forename: Navraj S
authors.initials: NS
authors.lastname: Nagra
authors.affiliation: Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Kimberley L
authors.initials: KL
authors.lastname: Edwards
authors.affiliation: The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom.
authors.forename: Eyal
authors.initials: E
authors.lastname: Behrbalk
authors.affiliation: The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom.
authors.forename: Bronek
authors.initials: B
authors.lastname: Boszczyk
keywords: conservative treatment; spondylolysis in athletes; surgical treatment