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OBJECTIVES: The aim of this study was to characterise the presentation, treatment, and management of adolescent athlete low back pain (LBP) as diagnosed in a clinical setting. The objectives were to 1) identify diagnoses associated with LBP in adolescent athletes; 2) categorise the differences in LBP diagnosis and presentation by sport, sex, BMI, and age; and 3) examine treatment and management methods of LBP in adolescent athletes. DESIGN: Retrospective chart review. METHODS: This retrospective medical chart review was conducted in the Sports Medicine Division of Boston Children's Hospital (BCH), a tertiary paediatric academic hospital. Data were collected and analysed from 363 adolescent athletes who had experienced LBP between 2015 and 2020. Chi-squared tests for association were used to assess for associations between LBP diagnoses and age, sex, BMI, and sport. Statistical analysis was conducted using SAS software version 9.4 (SAS Institute, Cary NC). RESULTS: Non-specific LBP was the most common LBP diagnosis amongst 363 adolescent athletes with LBP (34â¯%). This was closely followed by spondylolysis (28â¯%). There was a higher proportion of female athletes amongst participants diagnosed with facet-joint related pain (90â¯%) and SI-joint related pain (89â¯%) compared to the proportion of female athletes amongst participants diagnosed with spondylolysis (50â¯%). There was a high rate of diagnostic MRI usage in this cohort. Commonly used management techniques in this cohort were diagnostic MRI, physical therapy, relative rest, and bracing. CONCLUSIONS: An awareness of the sex-based differences in adolescent athlete LBP diagnoses may be useful for clinicians. It may be important to refine methods of diagnosis of LBP in this group, as there was a high rate of diagnostic MRI use. Future research should be directed towards the development of management guidelines specific to LBP in adolescent athletes to assist in the optimal management of this diagnosis.
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Dolor de la Región Lumbar , Humanos , Adolescente , Estudios Retrospectivos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/terapia , Femenino , Masculino , Atletas , Espondilólisis/diagnóstico , Espondilólisis/terapia , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Índice de Masa Corporal , Factores Sexuales , NiñoRESUMEN
BACKGROUND: Isthmic spondylolysis represents the most common cause of spinal pain in adolescent athletes. This article provides an overview of the classification, diagnosis, and treatment options for these conditions, including conservative and operative measures. It also provides a treatment pathway to how young athletes with spondylolysis should be treated. DIAGNOSTICS: Diagnostic imaging techniques are essential for an accurate diagnosis, with CT scans providing additional information for surgical planning. TREATMENT: Conservative treatment focuses on activity modification and physiotherapy, with a phased approach tailored to individual patient needs. Operative intervention may be considered if conservative measures fail, with minimally invasive techniques such as Buck's screw fixation showing promising results. The decision between conservative and operative management should consider factors of the patients' individual profile. In this paper, we present the first treatment algorithm for the treatment of isthmic spondylolysis. Long-term prognosis varies, with most athletes able to return to sport following treatment.
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Algoritmos , Espondilólisis , Adolescente , Humanos , Masculino , Traumatismos en Atletas/terapia , Traumatismos en Atletas/diagnóstico por imagen , Traumatismos en Atletas/cirugía , Tratamiento Conservador/métodos , Paratletas , Fútbol/lesiones , Espondilólisis/terapia , Espondilólisis/diagnóstico , Espondilólisis/diagnóstico por imagenRESUMEN
Introduction: Spondylolysis can either be asymptomatic or can cause significant low back pain. It is sometimes associated with the translation of one vertebra over another and is termed spondylolisthesis. The aim of the study was to find out the prevalence of spondylolysis among patients without low back pain in a diagnostic centre. Methods: A descriptive cross-sectional study was carried out in a referral diagnostic centre from 15 December 2018 to 14 December 2021 . Ethical approval was obtained from the Nepal Health Research Council (Reference number: 2903). Images of a computed tomography scan of the abdomen performed for other abdominal causes and without low back pain were reconstructed in the sagittal and coronal plane and evaluated for the presence of spondylolysis and spondylolisthesis in the lumbar spine. Demographic data were taken from the hospital records. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 768 patients without low back pain, spondylolysis was found in 59 (7.68%) (5.80-9.56, 95% Confidence Interval). Spondylolisthesis was found in only 16 (27.1%) individuals with spondylolysis. The majority of spondylolysis cases were encountered in L5 level in 54 (91.53%). The mean age of patients with spondylolysis was 41.9±14.46 years. Male to female ratio was 1:1.18. Conclusions: The prevalence of spondylolysis in our study was found to be similar to other studies done in similar settings. Keywords: low back pain; spondylolisthesis; spondylolysis.
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Dolor de la Región Lumbar , Espondilolistesis , Espondilólisis , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Espondilolistesis/complicaciones , Espondilolistesis/diagnóstico por imagen , Espondilolistesis/epidemiología , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/epidemiología , Estudios Transversales , Espondilólisis/diagnóstico , Espondilólisis/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Vértebras Lumbares/diagnóstico por imagenRESUMEN
ABSTRACT: Isthmic spondylolysis is a common cause of back pain in young athletes. The condition presents to numerous medical providers who employ a variety of different practices in diagnosis and management. The purpose of this study was twofold: to review the literature of diagnosis and management of the young athlete with isthmic spondylolysis and to survey Pediatric Research in Sports Medicine (PRiSM) members during the 2021 PRiSM Annual Meeting on practice patterns of diagnosis and management of the young athlete with isthmic spondylolysis. The response rate was 27%. Per respondents: 24% obtain oblique radiographs; 90% use magnetic resonance imaging as the advanced imaging modality; 60% treat with bracing; 57% recommend rest prior to physical therapy (PT); 53% prescribe return to sport activity restrictions. Although there are similarities in the diagnosis of isthmic spondylolysis in young athletes, this survey confirmed variability in management, especially bracing, timing of PT and return to sport activity restrictions.
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Espondilólisis , Medicina Deportiva , Deportes , Niño , Humanos , Pautas de la Práctica en Medicina , Espondilólisis/diagnóstico , Espondilólisis/terapia , AtletasRESUMEN
Although posterior column disorders, such as spondylolysis and spondylolisthesis, are not commonly encountered in the general population, athletic trainers frequently see these conditions in athletic and active individuals due to the repetitive spinal extension and rotational loads placed on the pars interarticularis while participating in sport. Athletic trainers can successfully evaluate patients with posterior column disorders by performing a complete and comprehensive clinical examination to identify the location of pain, test spinal stability, and recognize compensatory movement patterns. Conservative management typically leads to a successful outcome in this population, with rest, bracing, and the use of therapeutic exercise having the best supporting evidence. In this Current Clinical Concepts review, we outlined the etiology and risk factors frequently associated with disorders of the posterior column. Additionally, we synthesized the literature for common evaluation techniques and interventions associated with the posterior column and provided a proposed rehabilitation progression to use in a younger, athletic population.
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Espondilolistesis , Espondilólisis , Deportes , Humanos , Espondilólisis/complicaciones , Espondilólisis/diagnóstico , Espondilolistesis/terapia , Espondilolistesis/diagnóstico , Espondilolistesis/etiología , Terapia por Ejercicio/efectos adversos , Dolor , Vértebras LumbaresRESUMEN
OBJECTIVES: To develop a clinical algorithm for classifying acute lumbar spondylolysis from nonspecific low back pain in elementary school-aged patients using the classification and regression tree analysis. METHODS: Medical records of 73 school-aged patients diagnosed with acute lumbar spondylolysis or nonspecific low back pain were retrospectively reviewed. Fifty-eight patients were examined for establishing an algorithm and 15 were employed for testing its performance. The following data were retrieved: age, gender, school grades, days after symptom onset, history of low back pain, days of past low back pain, height, weight, body mass index, passive straight leg raise test results, hours per week spent on sports activities, existence of spina bifida, lumbar lordosis angle, and lumbosacral joint angle. Classification and regression tree analyses were performed 150 times using the bootstrap and aggregating method. Then, the results were integrated by majority vote, establishing an algorithm. RESULTS: Lumbar lordosis angle, days after symptom onset, body mass index, and lumbosacral joint angle were the predictors for classifying those injuries. CONCLUSION: The algorithm can be used to identify elementary school-aged children with low back pain requiring advanced imaging investigation, although a future study with a larger sample population is necessary for validating the algorithm.
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Lordosis , Dolor de la Región Lumbar , Espondilólisis , Niño , Humanos , Dolor de la Región Lumbar/diagnóstico , Estudios Retrospectivos , Vértebras Lumbares , Espondilólisis/diagnóstico , Espondilólisis/epidemiología , AlgoritmosRESUMEN
ABSTRACT: Spondylolysis, or pars defect, occurs in nearly half of children with back pain. Despite the marked prevalence, diagnosis of spondylolysis with spondylolisthesis often is delayed or missed secondary to referred pain and uncharacteristic presentation. This article describes an 8-year-old patient with 15 months of right heel pain who was initially treated by her primary care provider for presumed Sever disease before being referred to orthopedics. After orthopedic consultation, she was diagnosed with a high-grade spondylolisthesis with L5 nerve root compression. Although spondylolysis is an infrequent diagnosis, particularly in a patient this young, missing the diagnosis can significantly reduce a patient's quality of life.
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Espondilolistesis , Espondilólisis , Niño , Diagnóstico Tardío , Femenino , Humanos , Vértebras Lumbares , Calidad de Vida , Espondilolistesis/complicaciones , Espondilólisis/diagnósticoRESUMEN
BACKGROUND: Early-stage spondylolysis (ESS) is one of the common causes of acute low back pain (LBP) in adolescents. Although accurate diagnosis of ESS is important for providing appropriate treatment, differentiating ESS from other low back disorders is difficult by physical signs alone. OBJECTIVES: To elucidate the most common characteristic, namely, motion-provoking LBP, in patients with ESS. DESIGN: Retrospective comparative cohort study. METHOD: We included and categorized adolescents (n = 112; age, <18 years) with acute LBP (<1 month) into the ESS (n = 71) and nonspecific LBP (NS-LBP) (n = 41) groups based on magnetic resonance imaging (MRI) findings. Patients were evaluated using a visual analog scale (VAS), Oswestry Disability Index (ODI), and degree of pain using a numerical rating scale (NRS) provoked by hyperextension, hyperflexion, right and left rotations, and lateral bending in standing position.; the value were compared between the 2 groups. A cut-off value of significance was obtained using receiver operating characteristic (ROC) analysis. RESULTS: The mean scores for VAS and ODI and NRS of each test were as follows (ESS/NS-LBP): VAS, 6.5/6.0; ODI, 19.7/24.6; hyperextension, 4.1/4.1; hyperflexion, 2.4/3.0; rotation, 2.1/2.2; and lateral bending, 2.9/2.2. The ESS group had a significantly greater number of LBP cases provoked by lateral bending than the NS-LBP group. A cut-off lateral bending of 3.5 yielded a diagnosis of ESS. CONCLUSIONS: Our results indicate that lateral bending is the greatest motion-provoking characteristic of LBP in patients with ESS.
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Dolor de la Región Lumbar , Espondilólisis , Adolescente , Estudios de Cohortes , Evaluación de la Discapacidad , Humanos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/etiología , Estudios Retrospectivos , Espondilólisis/complicaciones , Espondilólisis/diagnósticoAsunto(s)
Espondilólisis , Tirantes , Humanos , Vértebras Lumbares , Región Lumbosacra , Espondilólisis/diagnóstico , Espondilólisis/terapiaAsunto(s)
Dolor de la Región Lumbar , Espondilólisis , Atletas , Humanos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/etiología , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Región Lumbosacra , Estudios Retrospectivos , Espondilólisis/diagnóstico , Espondilólisis/diagnóstico por imagenRESUMEN
RATIONALE: For isthmic lumbar spondylolisthesis (ILS) associated with the removal of herniation, it remains challenging to perform less invasive and minimally disruptive procedures. Good results could potentially be obtained by further preserving the posterior elements in full-endoscopic lumbar discectomy (FESS), which is less invasive than microenscopic surgery (MES). PATIENT CONCERNS: One patient complained of left leg pain, and another patient complained of right leg pain and low back pain. DIAGNOSES: Two patients with ILS and Meyerding Grade 1 lumbar spondylolisthesis. INTERVENTIONS: We performed a full-endoscopic lumbar discectomy via the interlaminar space (FESS-IL) for L5/S1 lumbar disc herniation (LDH) accompanied by isthmic lumbar spondylolisthesis. FESS-IL was performed in 2 patients with radiculopathy caused by different types of LDH using a full endoscopic system with a 4.1âmm working channel and 6.9âmm outer diameter. A 3.5-mm diameter high-speed drill was used in one patient for an upward-migrated LDH in the inner-rim of the infravertebral border. The other patient underwent minimal resection without bone resection. OUTCOMES: The one-year clinical outcome included confirmation of pain relief and evacuation of migrated LDH on magnetic resonance imaging in all patients. There was no progression of slippage on radiography. The mean operative time was 82âmin, and no complication was observed. The one-year clinical outcome demonstrated sufficient pain relief. LESSONS THE Y: ear postoperative outcome showed improvement. We believe that FESS-IL is a viable alternative operative approach for LDH for ILS.
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Discectomía/métodos , Endoscopía/métodos , Vértebras Lumbares/cirugía , Espondilolistesis/cirugía , Discectomía/instrumentación , Endoscopía/instrumentación , Femenino , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/etiología , Desplazamiento del Disco Intervertebral/cirugía , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Espondilolistesis/complicaciones , Espondilolistesis/diagnóstico , Espondilólisis/diagnóstico , Espondilólisis/etiología , Espondilólisis/cirugía , Resultado del TratamientoRESUMEN
Repetitive stress on the lumbosacral spine during sporting activity places the athletic patient at risk of developing symptomatic pars defect. Clinical history, physical examination, and diagnostic imaging are important to distinguish spondylolysis from other causes of lower back pain. Early pars stress reaction can be identified with advanced imaging, before the development of cortical fracture or vertebral slip progression to spondylolisthesis. Conservative management is first-line for low-grade injury with surgical intervention indicated for refractory symptoms, severe spondylolisthesis, or considerable neurologic deficit. Prompt diagnosis and management of spondylolysis leads to good outcomes and return to competition for most athletes.
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Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Vértebras Lumbares/lesiones , Espondilolistesis/diagnóstico , Espondilolistesis/terapia , Espondilólisis/diagnóstico , Espondilólisis/terapia , Traumatismos en Atletas/diagnóstico por imagen , Tratamiento Conservador , Diagnóstico Diferencial , Humanos , Dolor de la Región Lumbar/etiología , Vértebras Lumbares/diagnóstico por imagen , Anamnesis , Examen Físico , Volver al Deporte , Espondilolistesis/diagnóstico por imagen , Espondilólisis/diagnóstico por imagenRESUMEN
Back pain in sport is a common complaint and seen by athletes, trainers, and treating physicians. Although there are a multitude of pain generators, mechanical sources are most common. Certain sports can lead to increased mechanical and axial loading, such as competitive weightlifting and football. Common mechanical causes of pain include disk herniation and spondylolysis. Patients typically respond to early identification and conservative treatment. In others, surgical intervention is required to provide stability and prevent long-term sequelae.
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Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/terapia , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/terapia , Traumatismos en Atletas/diagnóstico , Tratamiento Conservador , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/terapia , Espondilólisis/complicaciones , Espondilólisis/diagnóstico , Espondilólisis/terapia , Estrés MecánicoAsunto(s)
Dolor de la Región Lumbar , Espondilólisis , Adolescente , Dolor de Espalda , Niño , Humanos , Espondilólisis/diagnósticoRESUMEN
STUDY DESIGN: Case-control study. OBJECTIVE: The aim of this study was to establish an algorithm to distinguish acute lumbar spondylolysis (LS) from nonspecific low back pain (NSLBP) among patients in junior high school by classification and regression tree (CART) analysis. SUMMARY OF BACKGROUND DATA: Rapid identification of acute LS is important because delayed diagnosis may result in pseudarthrosis in the pars interarticularis. To diagnose acute LS, magnetic resonance imaging (MRI) or computed tomography is necessary. However, not all adolescent patients with low back pain (LBP) can access these technologies. Therefore, a clinical algorithm that can detect acute LS is needed. METHODS: The medical records of 223 junior high school-aged patients with diagnosed acute NSLBP or LS verified by MRI were reviewed. A total of 200 patients were examined for establishing the algorithm and 23 were employed for testing the performance of the algorithm. CART analysis was applied to establish the algorithm using the following data; age, sex, school grades, days after symptom onset, history of LBP, days of past LBP, height, passive straight leg raising test results, hours per week spent in sports activities, existence of spina bifida, lumbar lordosis angle, and lumbosacral joint angle. Sensitivity and specificity of the algorithm and the area under the ROC curve were calculated to assess algorithm performance. RESULTS: The algorithm revealed that sex, days after symptom onset, days of past LBP, hours per week spent in sports activities, and existence of spina bifida were key predictors for identifying acute LS versus NSLBP. Algorithm sensitivity was 0.64, specificity was 0.92, and the area under the ROC curve was 0.79. CONCLUSION: The algorithm can be used in clinical practice to distinguish acute LS from NSLBP in junior high school athletes, although referral to MRI may be necessary for definitive diagnosis considering the algorithm's sensitivity.Level of Evidence: 4.
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Algoritmos , Atletas , Dolor de la Región Lumbar/diagnóstico , Espondilólisis/diagnóstico , Estudios de Casos y Controles , Sistemas de Apoyo a Decisiones Clínicas , Diagnóstico Diferencial , Humanos , Dolor de la Región Lumbar/fisiopatología , Análisis de Regresión , Estudios Retrospectivos , Espondilólisis/fisiopatologíaRESUMEN
STUDY DESIGN: Systematic review and case report. OBJECTIVE: Our study aims to present a new technique using three components to repair the pars defect: pedicle screws, rod and polyester band. Furthermore, we perform a systematic literature review of the previously described techniques. SUMMARY OF BACKGROUND: Spondylolysis is a common condition in children and adolescents. Depending on the severity it may be treated either nonoperatively or surgically. Surgery is required if nonoperative treatment failed to give sustained pain relief. Several surgical techniques have been described. METHODS: The literature review investigates the database (MEDLINE-EMBASE-Cochrane-ScienceDirect) up to May 2019 for studies presenting a surgical technique for spondylolysis.The Screw-Rod-Band (SRB) technique combines the use of pedicle screws, a rod and a polyester band to repair the spondylolysis. The horizontal rod connects the pedicle screws. The polyester band linked to the rod passes below the spinous process to apply compressive forces on the pars. RESULTS: Twenty-one out of 982 studies described a surgical procedure. Eight main different techniques were identified: Isthmic Screw, Wiring, Butterfly-Plate, Hook-Screw Construct, Shaped-Rod, Laminar-Screw, and two combination technique (Lag Screw and Tension Band Fixation and Cortical Screws and Spinous-Process ModularLink). Our technique showed immediate postoperative clinical improvement. No surgical or perisurgical complication occurred. CONCLUSION: The systematic literature review revealed a great number of surgical techniques for the spondylolysis, demonstrating the lack of consensus.SRB technique is an effective and simple treatment for pars fixation. The surgical procedure puts the pars under strong compression. The results are comparable with procedures present in the literature and seems capable to reduce the invasiveness and the risk of neurological injury. LEVEL OF EVIDENCE: 2.
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Vértebras Lumbares/cirugía , Tornillos Pediculares , Poliésteres , Procedimientos Quirúrgicos Robotizados/métodos , Fusión Vertebral/métodos , Espondilólisis/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Robotizados/instrumentación , Fusión Vertebral/instrumentación , Espondilólisis/diagnóstico , Adulto JovenRESUMEN
AIMS: The primary aim of this study was to develop a diagnostic cluster of common clinical findings that would assist in ruling out an active spondylolysis in adolescent athletes with low back pain (LBP). DESIGN: Retrospective case-series. SETTING: Hospital-based sports medicine clinic. PATIENTS: One thousand and twenty-five adolescent athletes with LBP (age 15.0 ± 1.8 years, 56% female) were reviewed. Active spondylolytic injuries were identified in 22% (n = 228) of these patients. MAIN OUTCOME MEASURE: presence or absence of active spondylolysis on advanced imaging. RESULTS: Through logistic regression analysis, pain with extension (p < 0.001), difference between active and resting pain ≥3/10 (p < 0.001), and male sex (p = 0.002) were identified as significantly associated with active spondylolysis. The clinical cluster had a sensitivity of 88% (95% CI 83%-93%) to help rule out active spondylolysis. The negative likelihood ratio was 0.34 (95% CI 0.23-0.51) and the negative predictive value was 90% (95% CI 86%-93%). Diagnostic accuracy of the cluster was acceptable (area under the curve = 0.72 (95% CI 0.69, 0.76; p < 0.001). CONCLUSION: This study found a cluster of three patient characteristics that may assist in ruling out active spondylolysis in adolescent athletes with LBP.
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Atletas , Dolor de la Región Lumbar/etiología , Espondilólisis/diagnóstico , Adolescente , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y Especificidad , Factores SexualesRESUMEN
Pediatric spine disorders are numerous and are quite different when compared with the adult population. This article focuses on some of the more common pediatric spine disorders. This article summarizes such disorders and discusses typical treatment options in the pediatric orthopedic armamentarium.