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Lumbar Spondylolysis

A Study of Natural Progression in Athletes

Sports Medicine Center, Children's Hospital Medical Center of Akron

John McCulloch, MD

Northeastern Ohio Universities College of Medicine, Akron, Ohio

Kenneth Swanson, MD

Sports Medicine Center, Children's Hospital Medical Center of Akron

We examined the natural course of athletically active young people with back pain and a diagnosis of spon dylolysis (stress fracture of the pars interarticularis of the facet joint of the lumbar spine). We limited the study to those with "subtle" fractures (normal radio graphs and positive bone scans) and used computed tomography scanning to further characterize this lesion and to determine whether we could demonstrate heal ing in this population. The study group included 40 patients with low back pain and a diagnosis of spon dylolysis by nuclear medicine study. Computed tomog raphy scans were performed with both traditional cuts and reverse-gantry angled cuts to help determine long- term treatment and prognosis. Forty-five percent of patients (18) demonstrated chronic nonhealing frac tures, 40% (16) demonstrated acute fractures in vari ous stages of healing, and 15% (6) demonstrated no obvious fractures. With the diagnosis of spondylolysis being fairly common in young athletes with low back pain, primary care physicians need to have a high index of suspicion in making the diagnosis. Computed tomography scans can play a very important role in diagnosis, assessment of the defect, short-term and long-term management decisions, and in determining prognosis.

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