Review of Nonoperative Treatment of Lumbar Spondylolysis and Spondylolisthesis
Introduction: Spondylolysis and spondylolisthesis can both be diagnosed throughout the lifespan of individuals who participate in sports. Both spondylolysis and spondylolisthesis can cause lower back pain due to instability of the lumbar spine. Spondylolysis is a unilateral or bilateral vertebral defect (eg, stress fracture) of the pars interarticularis, whereas spondylolisthesis is a displacement of a vertebra due to the pars defect. These disorders occur in different athletes, including dancers, gymnasts, and football players.
The researchers conducted a systematic review of nonoperative interventions for both spondylolysis and spondylolisthesis to determine the most effective treatments and rehabilitative modalities.
Methods: A computer-assisted literature search was conducted in the MEDLINE (US National Library of Medicine® biomedical database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and EMBASE (Excerpta Medica database) databases from 1966 to April 2012. The search utilized keywords related to nonoperative treatment of spondylolysis and/or spondylolisthesis.
Search parameters included the following criteria: English language, human study, lumbar pain with diagnosed spondylolysis and/or spondylolisthesis, at least one nonoperative treatment method, and use of a comparative study (cohort, case control, and/or cross sectional). A search through reference lists, textbooks, conference abstracts, and the Internet was conducted to locate all relevant articles that fit the inclusion criteria.
Two of the researchers independently extracted and cross-referenced data from the selected studies. If there was disagreement on the relevant data, it was discussed with and resolved by a third researcher.
Results: Ten studies met the criteria and were rated for quality using the Grading scale for spondylolysis and spondylolisthesis.
The nonoperative treatment studies were comparative or randomized clinical trials involving, bracing, bracing with physical therapy (PT), bracing with PT and nonsteroidal anti-inflammatory drugs, and specific exercises. Nonoperative treatment was shown to have positive results in Grades 0, 1, or 2. Poor patient compliance with exercise was noted by the investigators.
Five of the studies included surgical treatment, such as decompression, noninstrumented fusion, and posterolateral fusion. However, only four of those studies reported the degree of vertebral slippage.
Conclusion: The researchers found no consensus between nonoperative treatment versus surgical care in the treatment of spondylolysis or spondylolisthesis due to variability between the studies.
Garet M, Reiman MP, Mathers J, Sylvain J. Nonoperative Treatment in Lumbar Spondylolysis and Spondylolisthesis: A Systematic Review. Sports Health: A Multidisciplinary Approach. 2013;5:225-232.
The journal article is the result of a meta-analysis and review of the literature on the nonoperative treatment of spondylolysis and spondylolisthesis. A total of 518 articles published between 1966 and 2012 were found, however, only ten studies matched the search criteria. Keywords used in the search included, spondylolysis, spondylolisthesis, and nonoperative treatment.
The authors’ findings were that there was no consensus on the role of nonoperative versus surgical treatment.
Aside from the lack of treatment consensus, the salient findings are the difficulties of using a meta-analysis review to locate papers that will allow an apples-to-apples comparison of treatment options.