SUSPECTING LUMBAR SPONDYLOLYSIS IN ADOLESCENT LOW-BACK-PAIN

Spondylolysis in the athletic adolescent and preadolescent is common e nough that primary care practitioners should be familiar with its freq uency and its progression from pars interarticularis stress fracture t o spondylolysis and to spondylolisthesis. One-half of all pediatric ba ck pain in athletic patients is related to disturbances of the posteri or elements including spondylolysis, which presents as low back pain a ggravated by activity, frequently with minimal physical findings. Fail ure to suspect, hence to diagnosis, a pars stress fracture or early sp ondylolysis is common and a misdiagnosis of lumbosacral strain is ofte n made. A complicating factor in early diagnosis is the fact that plai n radiographs, even with oblique films, may not be helpful at the stre ss fracture stage, and other imaging techniques (bone scan possibly wi th single photon emission computed tomography [SPECT]) must be used ea rly in the diagnostic process. In the primary care setting, an early d iagnosis of posterior element involvement in low back pain either at t he stage of pars stress fracture or early spondylolysis can prevent pr ogression of the disease and the need for aggressive intervention for a more significant defect, We present three adolescent and preadolesce nt athletes with low back pain in whom a high index of suspicion led t o the early diagnosis of pars stress fracture or spondylolysis.;ill th ree had different stages of spondylolysis, and one illustrates the cli nical utility of the one-legged hyperextension test. The ease with whi ch early disease may be treated further supports efforts by primary ca re practitioners to suspect and diagnose pars stress fracture and earl y spondylolysis.