Supervisors info:
Βλάμης Ιωάννης, Επίκουρος Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Πνευματικός Σπυρίδων, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Ευαγγελόπουλος Δημήτριος-Στέργιος, Ακαδημαϊκός Υπότροφος, Ιατρική Σχολή ΕΚΠΑ
Summary:
Lumbar spondylolysis is a defect of the pars interarticularis and is a common cause
of low back pain in young athletes1
. Although multiple factors may be involved in its
pathogenesis, when it occurs among athletes it is currently considered to be a stress fracture 2–4. A plethora of epidemiologic studies suggest that the prevalence of
spondylolysis among athletes is being three to four times higher than that among the
general population2, 5 6
. Sports in which participants are subjected to repetitive
flexion hyperextension and rotational forces across the lumbar spine pose a risk for
such injuries 3, 7, 8
Treatment recommendations for spondylolysis vary throughout the literature. There
are no controlled trials regarding the relative efficacy of proposed management
protocols.
Initially, symptomatic spondylolysis can be managed conservatively with
activity modification, rest, Physical therapy, anti- inflammatory drugs and bracing.
Surgical treatment of spondylolysis can be considered after the failure of nonsurgical management and if neurological symptoms occurs9
Moreover, elite athletes with sports injuries usually desire an early return to their
original sporting activities. Therefore it is of paramount importance for physicians to
be able to inform them about the duration (RTP) and the estimated outcome of
proposed treatment.
Generally, conservative treatment leads to excellent results with the majority of
athletes returning to sporting activities within 3-6 months even without bony fusion 11
3, 12
. In case of surgical treatment major factors that influence decision making on
RTP are radiographic appearance and time from surgery13
. Typically, these athletes
are permitted to return to competition 12 months after the operation. However, the
majority of surgeons , strongly advice against the participation in collision sports
after an operation14
. A fusion may be career ending surgery for sports like gymnasts,
football, and weightlifting, while other athletes may be reduced from highly
competitive to recreational participants14, 15
Many authors have investigated until now the time return to play in association with
type of management, grade of spondylolysis , age and other factors 10, 16
. Although a
direct relationship between type of sport activity and prevalence of spondylolysis5
has been observed, any impact of specific sport activity to outcomes and RTP
remains unknown.
The purpose of this study is to review relative literature regarding the association of
specific athletic activity and both treatment outcomes and return-to-play time among
adolescent athletes with spondylolysis.
A comprehensive literature study based on a thorough Medline search from 1990 to
2020 using the following keywords: spondylolysis, athletes, treatment and time to
return to play was performed. Only studies providing data on specific sports were
included in the review. A total of 510 articles were initially retrieved from the search,
of which 15 were used in the final review.
Most of available data refers to soccer (9 articles and 155 athletes), tennis and
cricket. Regarding soccer, the mean RTP was 6–12 months and only 16 players
(10.3%) retired. About tennis, in total of 74 athletes only 4 retired (5.4 %) while the
mean RTP was 4.5 months. From 54 cricket players, two retired (3.7%) and the RTP
varies among 3-12 months. Scarce data regarding other sports precludes a valid
statistical analysis. Available data regarding soccer, tennis and cricket suggest a
retirement rate ranging from 3.7%-10.3% and an RTP from 3-12 months. Further
studies focusing on the type and level of sport activity as well as the treatment
protocol and outcome and return to play are warranted to better assess and manage
adolescent athletes with spondylolysis in daily practice.
Keywords:
Spondylolysis, Young athletes, Therapy, Return to play time
