European Spine Journal

, Volume 24, Issue 6, pp 1289–1295 | Cite as

Systematic review of observational studies reveals no association between low back pain and lumbar spondylolysis with or without isthmic spondylolisthesis

  • Nicholas S. Andrade
  • Carol M. Ashton
  • Nelda P. Wray
  • Curtis Brown
  • Viktor BartanuszEmail author
Review Article



The hypothesis that spondylolysis (SL) and/or isthmic spondylolisthesis (IS) cause low back pain (LBP) is widely accepted representing surgical indication in symptomatic cases. If SL/IS cause LBP, individuals with these conditions should be more prone to LBP than those without SL/IS. Therefore, the goal of the study was to assess whether the published primary data demonstrate an association between SL/IS and LBP in the general adult population.


Systematic review of published observational studies to identify any association between SL/IS and LBP in adults. The methodological quality of the cohort and case–control studies was evaluated using the Newcastle-Ottawa scale.


Fifteen studies met inclusion criteria (one cohort, seven case–control, seven cross-sectional). Neither the cohort study nor the two highest-quality case–control studies detected an association between SL/IS and LBP; the same is true for the remaining studies.


There is no strong or consistent association between SL/IS and LBP in epidemiological studies of the general adult population that would support a hypothesis of causation. It is possible that SL/IS coexist with LBP, and observed effects of surgery and other treatment modalities are primarily due to benign natural history and nonspecific treatment effects. We conclude that traditional surgical practice for the adult general population, in which SL/IS is assumed to be the cause of non-radicular LBP whenever the two coexist, should be reconsidered in light of epidemiological data accumulated in recent decades.


Spondylolysis Isthmic spondylolisthesis Low back pain Lumbar fusion Causality Association Adults Observational studies Review 


Conflict of interest


Supplementary material

586_2015_3910_MOESM1_ESM.docx (64 kb)
Supplementary material 1 (DOCX 64 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Nicholas S. Andrade
    • 1
  • Carol M. Ashton
    • 2
  • Nelda P. Wray
    • 2
  • Curtis Brown
    • 3
  • Viktor Bartanusz
    • 1
    Email author
  1. 1.Department of NeurosurgeryUniversity of Texas Health Science Center at San AntonioSan AntonioUSA
  2. 2.Center of Outcomes ResearchHouston Methodist Research InstituteHoustonUSA
  3. 3.Department of PhilosophyTrinity UniversitySan AntonioUSA

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