Diagnostic utility of patient history and physical examination data to detect spondylolysis and spondylolisthesis in athletes with low back pain: A systematic review (original) (raw)
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Journal of Babol University of Medical Sciences, 2015
BACKGROUND AND OBJECTIVE: Instability of the lumbar spine is one of the major causes of back pain and is considered as a subtype of non-specific lower back pain. Spondylolysis and spondylolisthesis due to this instability could lead to back pain. This systematic study aimed to review the published articles on the incidence of spondylolysis and spondylolisthesis. METHODS: In this study, we searched for English articles in databases of PubMed, Scopus, Elsevier, Ovid, CINAHL and ScienceDirect using key words such as spondylolisthesis, spondylolysis, prevalence, incidence, predisposing factors and epidemiology from 2000 to 2014. In addition, we searched in other databases including SID, IranMedex, Magiran and Medlib for the Iranian articles published during this period. FINDINGS: In total, 26 articles with dissimilar size and types of samples focusing on different spinal regions and variables were selected for this study. To assess the prevalence of spondylolisthesis and spondylolysis, 17 articles used plain radiography, seven articles used CT-scan and two articles used magnetic resonance imaging (MRI). Moreover, the prevalence of these disorders was investigated among children and athletes in four and five articles, respectively. With the exception of three articles on the incidence of cervical spondylolisthesis, other articles evaluated lumbar spondylolysis and spondylolisthesis. The total prevalence of spondylolysis and spondylolisthesis was estimated between 3-10% and 2-6%, respectively. CNCLUSION: According to the results of this review, spondylolysis and spondylolisthesis have a high prevalence in different populations. These disorders are more common among athletes and physically active individuals, and the incidence rate is higher among children with osteogenesis imperfecta compared to normal children.
The Spine Journal, 2016
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.
Clinical tests to diagnose lumbar spondylolysis and spondylolisthesis: A systematic review
Physical Therapy in Sport, 2015
The aim of this paper was to systematically review the diagnostic ability of clinical tests to detect lumbar spondylolysis and spondylolisthesis. A systematic literature search of six databases, with no language restrictions, from 1950 to 2014 was concluded on February 1, 2014. Clinical tests were required to be compared against imaging reference standards and report, or allow computation, of common diagnostic values. The systematic search yielded a total of 5164 articles with 57 retained for full-text examination, from which 4 met the full inclusion criteria for the review. Study heterogeneity precluded a meta-analysis of included studies. Fifteen different clinical tests were evaluated for their ability to diagnose lumbar spondylolisthesis and one test for its ability to diagnose lumbar spondylolysis. The one-legged hyperextension test demonstrated low to moderate sensitivity (50-73) and low specificity (17-32) to diagnose lumbar spondylolysis, while the lumbar spinous process palpation test was the optimal diagnostic test for lumbar spondylolisthesis; returning high specificity (87-100) and mixed sensitivity (60-88) values. Lumbar spondylolysis and spondylolisthesis are identifiable causes of LBP in athletes.
Frequency of spondylolysis and chronic low back pain in young soccer players
Coluna/Columna, 2014
Objective: To demonstrate the safety of soccer for adolescents in terms of chronic lesions of the lumbar spine, particularly spondylolysis. Methods: 54 young players underwent a pre-season assessment. The athletes were submitted to radiography of the lumbosacral spine. Players complaining of chronic low back pain were later submitted to more specific tests. Results: only 1 athlete (1.85 % of our sample) had complaints of chronic low back pain. In this case, the radiograph showed olisthesis grade I spondylolysis at the L5 level. Conclusion: Soccer proved to be a very safe sport in terms of the risk of developing chronic lesions of the lumbosacral spine. However, the actual incidence of spondylolysis in these athletes was not determined because only plain radiographs were used in this study.
Clinical outcome and return to sport after the surgical treatment of spondylolysis in young athletes
The Journal of Bone and Joint Surgery, 2003
e studied prospectively 22 young athletes who had undergone surgical treatment for lumbar spondylolysis. There were 15 men and seven women with a mean age of 20.2 years (15 to 34). Of these, 13 were professional footballers, four professional cricketers, three hockey players, one a tennis player and one a golfer. Preoperative assessment included plain radiography, single positron-emission CT, planar bone scanning and reverse-gantry CT. In all patients the Oswestry disability index (ODI) and in 19 the Short-Form 36 (SF-36) scores were determined preoperatively, and both were measured again after two years in all patients. Three patients had a Scott's fusion and 19 a Buck's fusion.
Variables associated with active spondylolysis
Physical Therapy in Sport, 2009
Study design: : Retrospective non-experimental study. Objective: To investigate variables associated with active spondylolysis. Design: A retrospective study audited clinical data over a two year period from patients with suspected spondylolysis that were referred for a SPECT bone scan. Six exploratory variables were identified and analysed using uni-and multi-variate regression from 82 patient records to determine the association between symptomatic, physical and demographic characteristics, and the presence of an active spondylolysis. Setting: Tertiary level multidisciplinary private practice sports medicine clinic. Participants: All patients with low back pain that required a SPECT bone scan to confirm suspected spondylolysis. 82 subjects were included in the final sample group. Main outcome measurements: The six exploratory variables included Age, Gender, Injury duration, Injury onset, Sports participation and the result of the Single Leg Hyperextension Test. The dependent outcome variable was the result of the SPECT bone scan (scan-positive or scan-negative). Results: Adolescent males had a higher incidence of spondylolysis detected by SPECT bone scan compared to other patients and a statistically significant association was demonstrated for both age (p ¼ 0.01) and gender (p ¼ 0.01). Subjects with an active spondylolysis were nearly five times more likely to be male and aged less than 20 years. Furthermore, the likelihood ratio indicated that adolescent males with suspected spondylolysis were three and a half times more likely to have a positive bone scan result. The Single Leg Hyperextension Test did not demonstrate a statistically significant association with spondylolysis (p ¼ 0.47). Conclusions: Clinicians assessing for a predisposition to the development of spondylolysis should consider the gender and age of the patient and not rely on the predictive ability of the Single Leg Hyperextension Test.
Spondylolysis in Young Athletes: An Overview Emphasizing Nonoperative Management
Journal of Sports Medicine, 2020
Lumbar spondylolysis is a unilateral or bilateral defect of the pars interarticularis, an isthmus of bone connecting the superior and inferior facet surfaces in the lumbar spine at a given level. Spondylolysis is common in young athletes participating in sports, particularly those requiring repetitive hyperextension movements. The majority of young athletes are able to return to full sport participation following accurate diagnosis and conservative management, including a structured treatment program. Surgical intervention for isolated pars injuries is seldom necessary. A progressive physical therapy (PT) program is an important component of recovery after sustaining an acute pars fracture. However, there is a paucity of literature detailing PT programs specific to spondylolysis. Here, we provide an overview of the epidemiology, natural history, radiographic evaluation, and management of pars fractures in young athletes. In addition, a detailed description of a physiotherapy program...
Global Spine Journal, 2016
Study Design: Retrospective consecutive case series. Objectives: Only few sporting individuals with symptomatic lumbar pars injuries require surgical repair and it is often difficult to predict the outcome following surgery. The factors that predict the outcome after direct repair of lumbar pars defect was evaluated clinically and statistically. The preoperative background variables both subjective and objective as well as radiological evaluation were used in a multiple regression model to find the strong predictors of postoperative outcome as measured by VAS (visual analogue scores), ODI (Oswestry Disability Index) and SF-36 (Short Form). Methods: Fifty-two consecutive young sporting individuals with a mean age of 19 years (range 8-30 years) were treated surgically for lumbar pars defect confirmed on imaging studies (ie, single-photon emission computed tomography, computed tomography, and magnetic resonance imaging). Fifty patients completed the VAS, ODI, and SF-36 questionnaires as a part of their assessment. Preoperative background variables were used in a multiple regression model to find the strongest predictor of postoperative outcome as measured by ODI. Ethical approval was taken by the institutional review board. Results: Buck's screw repair of the pars defect was carried out in 44 patients (33 males, 11 female): unilateral in 8 patients (7 males, 1 female) and bilateral in 36 patients (26 males, 10 females). Although age at surgery showed linear colinearity (r ¼ 0.32, P < .05), it was not significant in the model. The most consistent association with the preoperative VAS score were the pre-and postoperative ODI scores, that is, r ¼ 0.51 (P < .01) and r ¼ 0.33 (P < .05), respectively. In the bilateral group, with Buck's repair at a single level, that is, 33 of 36 (93%) patients had returned to sports at a mean time of 7.5 months (range 6-12 months). Overall, 44 of 52 (84%) individuals had returned to their sports with posttreatment ODI score of <10. The stepwise regression modeling suggested 6 independent factors (preoperative ODI, preoperative SF-36 physical component summary (PCS), Buck's repair, multiple operations, professionalism, and pars defect at L3), as the determinants of the outcome (ie, postoperative ODI) in 80.9% patients (R 2 ¼ 0.809). Conclusions: The outcome after direct repair of pars defect in those younger than 25 years runs a predictable course. Professionalism in sports has a high impact on the outcome. Preoperative ODI and SF-36 PCS scores are significant predictors of good functional outcome. The regression equation can predict the outcome in 80.9% sporting individuals undergoing Buck's repair.