Treatment of Acute Spondylolysis in Elite athletes. Literature Review and Presentation of a New Percutaneous Grafting Technique

Spondylolysis is a defect of the pars interarticularis, eventually causing low back pain. It mostly occurs as a stressfracture, but can be congenital as well. The incidence in the adult Caucasian population is around 6%. It’s more common in males then in females [1]. Young athletes are most vulnerable, especially in sports requiring repetitive hyperextension and rotational loading: gymnasts, football players, weightlifters, wrestlers and dancers [2]. It mostly affects L5 (71-95%). Secondary spondylolisthesis occurs in 75% of cases [3,4]. For acute spondylolysis in young athletes conservative treatment is the preferred initial treatment. When diagnosed early the majority of athletes will resume their sporting activities after 3-6 months [5]. The longer the symptoms are present, the more likely that conservative treatment will be insufficient [6]. Unilateral active lesions have a higher tendency to heal then bilateral lesions [7]. Conservative treatment consists of lumbosacral orthosis, activity modification, and rehabilitation [6]. There is no consensus on the value and duration of bracing, the type of brace used, and the duration of sports restriction. Athletes should be pain free before they return to sport [5].