Spondylolysis and Spondylolisthesis in Adolescent Athletes: a narrative review

Abstract

Background. Spondylolysis, a stress-induced fracture of the lumbar pars interarticularis, and its sequela spondylolisthesis are among the most frequent structural causes of low back pain in adolescent athletes, particularly those practising sports requiring repetitive hyperextension and rotation of the lumbar spine. Despite long clinical experience, heterogeneity persists regarding optimal imaging strategy, conservative treatment duration, bracing indications, and criteria for surgery.

Aim. To synthesise current evidence on the epidemiology, pathophysiology, diagnostic imaging, conservative and surgical management, and return-to-sport outcomes of spondylolysis and spondylolisthesis in adolescent athletes, while critically appraising the strength and consistency of the underlying evidence.

Materials and Methods. Narrative review of peer-reviewed English-language epidemiological studies, hospital and registry-based case series, systematic reviews and meta-analyses, randomised controlled trials, biomechanical and imaging-validation studies, and expert consensus statements on spondylolysis and spondylolisthesis in young and adolescent athletes.

Results. Spondylolysis accounts for a substantial proportion of low back pain presentations in adolescent athletes, with marked sport-specific variation in incidence and lesion distribution. Magnetic resonance imaging has progressively supplanted computed tomography and single-photon emission computed tomography as the preferred modality, balancing sensitivity against radiation exposure.

Conclusions. Early recognition, individualised imaging strategies, and staged conservative rehabilitation remain central to management, though gaps persist regarding optimal rest duration, bracing necessity, and long-term recurrence prevention.