Results of Three-Prong Treatment Program for Spondylolysis

Young children involved in certain sports can experience a fracture of the pars interarticularis. This condition is called spondylolysis.

The pars is a part of the posterior half of the vertebra. If the fracture displaces (separates), the body of the vertebra can slide forward. This more advanced condition is referred to as spondylolisthesis.

The cause and nonoperative treatment of spondylolysis are the focus of this article. Medical management is made up of three parts: reduction of activity, a back brace, and physical therapy.

Activities that must be avoided include hyperextension (backward bending motion) and twisting of the spine. Athletic training must be abandoned by football players, wrestlers, soccer players, gymnasts, or other sports participants. Any twisting or extension of the spine must be avoided.

If painful symptoms do not resolve, then an orthosis (back brace) may be prescribed. A custom made thoracolumbar orthosis (TLSO) must be worn everyday for at least three months. The child can be slowly weaned from the brace at the end of that time. A physical therapy program of range of motion, stretching, strengthening, and correct posture is then initiated.

In a study of 436 children who followed these three steps, results were excellent. Full cooperation and compliance with activity restrictions, brace wearing, and gradual return to sports was required to obtain such good outcomes. All of the patients were able to return to their sport full-time. No one needed further treatment or surgery.

When athletes return to their sport, they must learn how to avoid improper technique. They must to trained to avoid motions that stretch beyond their physical abilities and strength.