Spondylolysis of young athletes — surgery can be a viable option

Using pars defect repair and Scott’s wiring technique, orthopaedists produced a 100% union rate in young Japanese athletes.

Issue: Issue 6 2003

ByKatsuji Shimizu, MD, DMSc

--- Katsuji Shimizu, MD, DMSc

Spondylolysis is a bony defect of pars interarticularis. It is a nonunion based on a fatigue fracture caused by strenuous physical activity during the maturation/growing period. The tendency to have an established nonunion is influenced largely by genetics.

It is well known that spondylolysis is somewhat common among Alaskan Eskimos. Japanese people share a common genetic background with Alaskan Eskimos and, as such, have a fairly high incidence of spondylolysis as well.

The incidence of spondylolysis among young people in Japan is reported to be 4%, but it is significantly higher if the statistics are focused on the sports population. The incidence varies among the different sports and is reported to affect 14% of college Sumo wrestlers and 15.9% of junior ice hockey players. As many as 54% of professional baseball players in Japan may have symptomatic or asymptomatic spondylolysis.

Conservative treatment approaches

Young athletes often have to make a decision whether to continue their sports activity with nonunion and pain, or bet their young sports career on the unpredictable result of “conservative” treatment.

There are two basic forms of conservative treatment of spondylolysis. Patients can undergo the external support of a cast or orthosis for a certain period to achieve fracture union. A supplement of electric current or an electromagnetic field may improve the union rate to some extent; however, the overall union rate after external support does not exceed 50%.

The other conservative treatment is simply to ease symptoms (and not strive for bone union), relying instead on physical therapy, nonsteroidal anti-inflammatory drugs and pars defect block. The latter treatment is most popular among young athletes because the former do not promise a 100% guarantee of union after a long period of external support and rest from sports.

A surgical option

We have treated spondylolysis in non-sports populations by pars defect repair and Scott’s wiring technique for several years and recognized that it is an anatomical repair and is different from nonphysiological spondylodesis, which sacrifices motion segment.

Recently, we applied the same surgical technique to young athletes, including competitive athletes, which resulted in a 100% union rate (ie, bony fusion at the site of spondylodesis). The only disadvantage of this treatment is that rehabilitation is necessary before they return to a competitive level of sports activity.

Approximately six months after surgery, these young athletes usually start jogging and isometric exercises and gradually return to competition approximately six months later. It is necessary to have a one-year leave from competition to complete surgery and the rehabilitation process.

Surgery is a viable treatment option — with predictable results — for young athletes if they are willing to take a year off from their competitive sports activities.

Katsuji Shimizu, MD, DMSc, is professor and chairman of the department of orthopaedic surgery at Gifu University School of Medicine, Gifu, Japan. He is an editor of Orthopaedics Today.

For your information:

Nozawa S, Shimizu K, Miyamoto K, Tanaka M: Repair of pars interarticularis defect by segmental wire fixation in young athletes with spondylolysis. Am J Sports Med. 31:359-364;2003

Scott JHS. The Edinburgh repair of isthmic spondylolysis. J Bone & Joint Surg. 69-B:491;1987.