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Treatment of Adolescent Spondylosis

Although most back pain in children and adolescents is shortlived and nonspecific, some can be diagnosed as spondylolysis. This is a stress fracture of the pars interarticularis, a portion of the vertebra of the spine. The lumbar spine usually has five levels, numbered one through five. Spondylolysis most commonly occurs at the L4 or L5 level. It seems to occur more often amoung athletes participating in sports such as football, volleyball, gymnastics, wrestling, soccer, and tennis. It is the repetitive bending backward, called hyperextension that is thought to cause the stress fracture. The diagnosis is usually made by the history and radiographs such as plain xrays, bone scan, or computed tomography. Plain xrays were falsely negative in three fourths of the subjects. The spondylolysis in the remaining subjects was found with either a bone scan or CT scan.

The authors of the study reviewed the cases of 255 males and 181 juvenile and adolescents who were evaluated and diagnosed as having spondylolysis by a single physician. Back pain with extension, back spasms, and hamstring tightness were typical symptoms.

Initial treatment of the subjects in this study included stopping the activity that caused the symptoms, and wearing a custom fitted brace for three months. Treatment also included rehabilitation for strengthening of the abdominals and muscles along the spine. In the subjects who responded to conservative care, range of motion of the spine and hamstring length was restored without pain. Back spasm was eliminated. Most subjects returned to their preinjury activity level. Various studies have shown that conservative, nonoperative treatment is effective 78 to 95 percent of the time. Of the 436 subjects in this study, 95 percent of them had a favorable outcome.

References: M.F. Kurd, et.al. Journal of Spinal Disorders and Technology, Volume 20, Number 8, December 2007. Pp. 560-564.

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