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Benign Natural History of Spondylolysis in Adolescence With Midterm Follow-Up

  • Case Series
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Abstract

Study Design

Retrospective chart review.

Objectives

To use the Micheli Functional Scale to assess adolescent patients with spondylolysis treated conservatively at midterm follow-up.

Summary of Background

Spondylolysis is a common source of back pain for adolescents and is generally managed with bracing and physical therapy. There is little data regarding the results of conservative management of spondylolysis over time.

Methods

Four major academic pediatric institutions performed a retrospective chart review of patients from 5 to 21 years of age with the initial diagnosis of spondylolysis. Inclusion criteria were patients who initially underwent conservative management and had a minimum of 2 years’ follow-up. The patients were contacted and asked to complete the Micheli Functional Scale Survey.

Results

A total of 295 patients with the diagnosis of spondylolysis were identified and contacted. Sixty-one subjects with spondylolysis completed the follow-up survey. Sixty of 61 respondents (98%) answered questions regarding their current pain level. Thirty-five of 60 (58.3%) reported no pain (0/10) and 47/60 (78%) rated their pain at 3 or less, whereas 22% (13/60) rated their pain as 4 or higher. There was no correlation with pain ratings on the follow-up survey and radiographic healing at initial management.

Of the 61 patients, 50 returned to sports (82%), 8 did not return (13%), and 5 returned to most but not all of their sports (8%). No correlation was observed between radiographic healing and return to sports (p = .4885).

Conclusion

Using a validated functional scale, this study demonstrated that with conservative management of spondylolysis a majority of patients at an average of 8 years out self-report a return to sports (90%), though many reported continued pain (42%) and interference with activities (67%). There was no correlation observed between radiographic evidence of healing and pain or return to sports with a mean follow-up of 8 years.

Level of Evidence

Multicenter retrospective case series.

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Authors and Affiliations

  1. Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #69, Los Angeles, CA, 90027, USA

    Ted Sousa MD, David L. Skaggs MD, MMM, Priscella Chan MS & Lindsay M. Andras MD

  2. Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, 90095, USA

    Kent T. Yamaguchi Jr. MD & Christopher Lee MD

  3. Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN, 38104, USA

    Jerald Borgella BS & Jeffrey Sawyer MD

  4. LeBonheur Children’s Hospital, 51 N Dunlap St #100, Memphis, TN, 38105, USA

    Alice Moisan RN

  5. Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    John M. Flynn MD & Melissa Gunderson BA

  6. Division of Sports Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115, USA

    M. Timothy Hresko MD & Pierre D’Hemecourt MD

Authors
  1. Ted Sousa MD
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  2. David L. Skaggs MD, MMM
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  3. Priscella Chan MS
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  4. Kent T. Yamaguchi Jr. MD
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  5. Jerald Borgella BS
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  6. Christopher Lee MD
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  7. Jeffrey Sawyer MD
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  8. Alice Moisan RN
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  9. John M. Flynn MD
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  10. Melissa Gunderson BA
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  11. M. Timothy Hresko MD
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  12. Pierre D’Hemecourt MD
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  13. Lindsay M. Andras MD
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Corresponding author

Correspondence to David L. Skaggs MD, MMM.

Additional information

Author disclosures

TS (none); DLS (reports personal fees from Biomet, Grand Rounds, Medtronic, Orthobullets, Zipline Medical Inc., Johnson & Johnson, and Wolters Kluwer Health–Lippincott Williams & Wilkins; nonfinancial support from Growing Spine Foundation, Growing Spine Study Group, Scoliosis Research Society, Journal of Children’s Orthopaedics, Spine Deformity; other from Zipline Medical Inc., outside the submitted work); PC (none); KTY (none); JB (none); CL (none); JS (reports other from American Academy of Orthopaedic Surgeons, Campbell Foundation, and the Pediatric Orthopaedic Society of North America; personal fees from DePuy, A Johnson & Johnson Company; NuVasive, other from Medicrea Spine, Mosby, and Wolters Kluwer Health–Lippincott Williams & Wilkins, outside the submitted work); AM (none); JMF (reports other from Biomet, outside the submitted work); MG (none); MTH (reports personal fees from Abbott, AbbVie, GlaxoSmithKline, Horizon Pharma, Lilly, Merck, and SeraCare; nonfinancial support from AbbVie and Lilly; other from American College of Rheumatology/Arthritis Foundation, Pediatric Orthopaedic Society of North America, Scoliosis Research Society, Arthritis and Rheumatism, and Johnson & Johnson, outside the submitted work); PD (none); LMA (reports personal fees from Biomet, Medtronic, and Orthobullets; other from Eli Lilly; nonfinancial support from Pediatric Orthopaedic Society of North America and Scoliosis Research Society, outside the submitted work).

This study has been carried out with approval from the Committee on Clinical Investigations at Children’s Hospital Los Angeles.

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Sousa, T., Skaggs, D.L., Chan, P. et al. Benign Natural History of Spondylolysis in Adolescence With Midterm Follow-Up. Spine Deform 5, 134–138 (2017). https://doi.org/10.1016/j.jspd.2016.10.005

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  • DOI: https://doi.org/10.1016/j.jspd.2016.10.005

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