Lumbosacral Spondylolysis Follow-up

Updated: Sep 05, 2018
  • Author: Achilles Litao, MD; Chief Editor: Craig C Young, MD  more...
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Follow-up

Return to Play

Return to play of an athlete with lumbosacral spondylolysis (lumbar spondylolysis) is first begun with low-level sport activities after the follow-up visit at 4-6 weeks, after which gradual increase in intensity as tolerated is allowed under supervision. [38] Return to full activity is permitted only when patients are totally asymptomatic with full range of motion. [12] Patients must also have normal flexibility and normal strength and balance.

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Complications

Complications of lumbosacral spondylolysis (lumbar spondylolysis) include a progression to spondylolisthesis (ie, slippage of the vertebrae and its sequelae) as well as delayed diagnosis and nonunion with chronic pain.

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Prevention

Because the etiology of lumbosacral spondylolysis (lumbar spondylolysis) is unknown and factors that cause slippage are unknown, prevention suggestions are unavailable. However, athletes must be advised that preventing recurrences may prove difficult if they return to high-level competition.

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Prognosis

If treatment is instituted early, lumbosacral spondylolysis (lumbar spondylolysis) can be successfully treated with conservative management. [2] The cure rate for early lumbosacral spondylolysis (lumbar spondylolysis) with activity restriction and a thoracolumbosacral orthosis is 73%, whereas more advanced spondylolyses were found to be less responsive to this regimen. [2]

With history and physical examination findings compatible with lumbosacral spondylolysis (lumbar spondylolysis), athletes with normal findings on plain radiography and bone scanning are most likely to have pathology other than a pars defect. They are presumed to have a chronic back strain, and further investigation of the cause of the back pain is indicated while they are placed on physical therapy. Studies are repeated in 6-8 weeks if patients are still symptomatic with physical therapy. [12] MRI is appropriate in this setting. [30]

Surgical treatment is an option for persistently symptomatic patients who did not achieve bony healing with activity restriction and bracing. [39, 40, 41, 42, 43, 44, 45] Bony union has also been reported with transcutaneous electrical stimulation (TENS) in this group of patients. [46]

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Education

All athletes, especially those younger than 18 years, should know that not all sources of back pain are muscular and, therefore, should not be ignored if persistent. This is most important if the athlete is participating in gymnastics, football, dancing, or figure skating.

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