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Diagnosis of Spondylolysis and Spondylolisthesis Is Delayed Six Months After Seeing Nonorthopedic Providers

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Abstract

Study Design

Retrospective single center.

Objective

Our purpose was to quantify the time to diagnosis of spondylolysis/spondylolisthesis in symptomatic patients after first seeking medical care.

Summary of Background Data

Several studies have found a high prevalence of pars defects in adolescent athletes with back pain, up to 47%. A review by the Scoliosis Research Society Evidence-Based Medicine Committee reports that both nonsurgical and surgical treatment of symptomatic spondylolysis effectively relieves pain and allows most patients to return to activities. Nonoperative treatment outcomes improve with early diagnosis.

Methods

A retrospective chart review was conducted of patients presenting at our institution between 2005 and 2015 with symptomatic spondylolysis or spondylolisthesis with radiographic confirmation. Medical records were reviewed for demographics, date of symptom onset, date of initial presentation to a health care provider, type of provider, and date of diagnosis.

Results

Forty-six patients met the inclusion criteria. Average patient age was 14 years (range: 6–19 years). Forty-one percent (19/46) of patients had spondylolysis, and 59% (27/46) of patients had spondylolisthesis. Of those with spondylolisthesis, 20 had grade I, 4 had grade II, 2 had grade III, and 1 had grade IV slips. The average time between onset of symptoms and initial presentation was 24 weeks (orthopedic: 21 weeks, nonorthopedic: 29 weeks, unknown: 18 weeks; p = .26). The average delay between initial presentation to a health care provider and diagnosis was 15 weeks. Time from initial presentation to diagnosis was 1 week for orthopedic surgeons, 25 weeks for nonorthopedic providers, and 10 weeks for unknown providers; this difference was significant (p = .02).

Conclusion

Diagnosis of spondylolysis/spondylolisthesis was significantly longer after seeing a nonorthopedic versus an orthopedic provider. Education of primary care providers on this topic is warranted. Children suffering from back pain from spondylolysis/spondylolisthesis may benefit from early referral to an orthopedic surgeon.

Level of Evidence

Level II.

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Authors and Affiliations

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

    Ena Nielsen BA, Lindsay M. Andras MD & David L. Skaggs MD, MMM

Authors
  1. Ena Nielsen BA
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  2. Lindsay M. Andras MD
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  3. David L. Skaggs MD, MMM
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Corresponding author

Correspondence to David L. Skaggs MD, MMM.

Additional information

Author disclosures: EN (none); LMA (personal fees from Biomet; Medtronic, other from Eli Lilly, other from Orthobullets, other from Journal of Pediatric Orthopaedics, other from Pediatric Orthopaedic Society of North America and the Scoliosis Research Society, outside the submitted work); DLS (other from Growing Spine Study Group; Scoliosis Research Society; Growing Spine Foundation, personal fees from ZimmerBiomet, Medtronic, Zipline Medical, Inc., Orthobullets, Grand Rounds [a health care navigation company], and Green Sun Medical, grants from Pediatric Orthopaedic Society of North America and the Scoliosis Research Society, paid to Columbia University; Elipse (Co-PI, paid to GSF), other from Zipline Medical, Inc., Green Sun Medical, Orthobullets, personal fees from ZimmerBiomet; Medtronic; Johnson & Johnson, other from Medtronic and ZimmerBiomet, nonfinancial support from Wolters Kluwer Health–Lippincott Williams & Wilkins; Biomet Spine, other from Orthobullets, Co–Editor in Chief, outside the submitted work).

All figures and tables in this manuscript are used with permission of the Children’s Orthopaedic Center, Los Angeles.

This study has been carried out with approval from the Institutional Review Board at Children’s Hospital Los Angeles.

None of the authors received financial support for this study.

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Nielsen, E., Andras, L.M. & Skaggs, D.L. Diagnosis of Spondylolysis and Spondylolisthesis Is Delayed Six Months After Seeing Nonorthopedic Providers. Spine Deform 6, 263–266 (2018). https://doi.org/10.1016/j.jspd.2017.10.008

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  • DOI: https://doi.org/10.1016/j.jspd.2017.10.008

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