DEFECTS OF PARS INTERARTICULARIS IN ATHLETES - A PROTOCOL FOR NONOPERATIVE TREATMENT

The purpose of this study was to report the results of a specific trea tment protocol for athletes with spondylolysis or spondylolisthesis of the lumbar spine. A retrospective study with recent follow-up was per formed on 82 patients treated with restriction of activity, bracing, a nd physical therapy. All of the patients were involved in sports at fi rst onset of symptoms. Sixty-six patients were boys and 16 were girls. Activities involving repetitive hyperextension and/or extension rotat ion of the lumbar spine were described as painful in 98% of the patien ts. Of the 62 patients with spondylolysis, 53 (85%) had an L5 defect a nd nine (15%) an L4 defect (90% of these 62 patients' defects were loc ated in the most caudad mobile vertebra). Thirty-seven patients had bi lateral pars defects, and 25 had unilateral defects. Eight patients ha d normal roentgenograms, but these eight had abnormal bone scans. Nine patients with spondylolysis underwent posterolateral fusion. Average follow-up was 4.2 years. Fifty-two (84%) had excellent results, eight had good results, and two had fair results. Twenty patients had a spon dylolisthesis: 12 were grade I, six were grade II, and two were grade III. Twelve patients (60%) required surgery; 9 had excellent results, one had good results, one had a fair result, and one had a poor result . Pars defects must be suspected in the differential of low back pain in young athletes. Oblique radiographs are frequently diagnostic; howe ver, if the history and examination are suggestive despite normal plai n films, a bone scan should be obtained. Nonoperative management of pa rs defects is frequently successful. The nonoperative prescription use d was the cessation of all athletic and exercise activities. Full-time use of a lumbosacral orthosis was required for a minimum of 2 months or until lumbar extension could be performed actively. When pain relie f was achieved and a course of physical therapy was completed, the pat ient was released to resume his or her previous activities. Indication s for operative intervention include unremitting symptoms despite 6 mo nths of nonoperative management, progression of spondylolisthesis, or neurologic deficit.