Return to Play in Adolescent Athletes With Symptomatic Spondylolysis Without Listhesis: A Meta-Analysis - PubMed (original) (raw)

Review

Return to Play in Adolescent Athletes With Symptomatic Spondylolysis Without Listhesis: A Meta-Analysis

Samuel C Overley et al. Global Spine J. 2018 Apr.

Abstract

Study design: Meta-analysis.

Objectives: To assess return to play (RTP) rates in adolescent athletes with lumbar spondylolysis without spondylolisthesis treated conservatively or operatively.

Methods: A review of Medline, EMBASE, and Cochrane Reviews was performed. The pooled results were performed by calculating the effect size based on the logit event rate. Studies were weighted by the inverse of the variance. Confidence intervals were reported at 95%. Heterogeneity was assessed using the Q statistic and _I_2 value.

Results: The initial literature search resulted in 724 articles, of which 29 were deemed relevant on abstract review. Overall, 11 studies provided data for 376 patients with a pars interarticularis defect. Return to athletic competition, based on logit event rate, was found to be statistically favored after both nonoperative and operative treatment (92.2% vs 90.3%). There was no heterogeneity noted among the studies reporting nonoperative treatment (Q value of 4.99 and _I_2 value of 0). There was mild heterogeneity within the operative studies (Q value of 3.54 and _I_2 value of 15.18).

Conclusions: Adolescent athletes RTP 92.2% of the time with nonoperative management, compared with 90.3% when treated operatively, though both treatment groups strongly favor RTP. As this is the first study to pool results of all relevant literature, it provides strong evidence to guide decision making and help manage expectations in this unique patient population.

Keywords: adolescent athletes; meta-analysis; return to play; spondylolysis.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

Figure 1.

PRISMA flow chart.

Figure 2.

Figure 2.

Forest plot of the logit event rate for return to play following nonoperative management.

Figure 3.

Figure 3.

Forest plot of the logit event rate for return to play following operative management.

Figure 4.

Figure 4.

Funnel plot depicting selection bias.

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