title: Current Evidence Regarding the Surgical and Nonsurgical Treatment of Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence-Based Medicine Committee.
abstract: METHODS
  Structured literature review.
  
  
  OBJECTIVE
  The Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric spondylolysis with the goal of identifying both what is really known and what research remains essential to further understanding.
  
  
  BACKGROUND
  Spondylolysis is common among children and adolescents and no formal synthesis of the published literature regarding treatment has been previously performed.
  
  
  METHODS
  A comprehensive literature search was performed. The researchers reviewed abstracts and analyzed by committee data from included studies. From 947 initial citations with abstract, 383 articles underwent full text review. The best available evidence for clinical questions regarding surgical and nonsurgical treatment was provided by 58 included studies. None of the studies were graded as level I or level II evidence. Two of the studies were graded as level III evidence. Fifty-six of the studies were graded as level IV evidence. No level V (expert opinion) studies were included in the final list.
  
  
  RESULTS
  Although natural history studies suggest a benign, relatively asymptomatic course for spondylolysis in most patients, both nonsurgical and surgical treatment series suggest that a substantial number of patients present with pain and activity limitations attributed to spondylolysis. Pain resolution and return to activity are common with both nonsurgical and surgical treatment (80% to 85%, respectively). Although it is implied that most surgically treated patients have failed nonsurgical treatment, the specific treatment modalities and duration required before failure is declared are not well defined. There is insufficient evidence to know which patients will benefit from specific treatment modalities (both nonsurgical and surgical).
  
  
  CONCLUSIONS
  Because of the preponderance of uncontrolled case series and the lack of comparative studies, only low-quality evidence is available to guide the treatment of pediatric spondylolysis.
authors.affiliation: Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA; Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA. Electronic address: chcraw01@gmail.com.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Crawford
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA.
authors.forename: Charles G T
authors.initials: CG
authors.lastname: Ledonio
authors.affiliation: Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO 80205, USA.
authors.forename: Robert Shay
authors.initials: RS
authors.lastname: Bess
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110, USA.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Buchowski
authors.affiliation: Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3017, Kansas City, KS 66160, USA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Burton
authors.affiliation: Department of Orthopaedic Surgery, Stanford School of Medicine, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, USA.
authors.forename: Serena S
authors.initials: SS
authors.lastname: Hu
authors.affiliation: Department of Orthopaedic Surgery, New York University Langone Medical Center, 820 2nd Avenue, Suite 7A, New York, NY 10017, USA.
authors.forename: Baron S H
authors.initials: BS
authors.lastname: Lonner
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Polly
authors.affiliation: Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA 22908, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Sanders
keywords: Evidence-based medicine; Isthmic spondylolisthesis; Lumbar spondylolysis; Structured literature review; Treatment