A multivariate analysis of radiographic healing in pediatric athletes diagnosed with spondylolysis

Why This Matters

Spondylolysis is a common cause of low back pain in adolescent athletes, often managed conservatively with good clinical outcomes. However, radiographic healing is not always assessed, and uncertainty remains about which patients are most likely to heal. This study helps clarify healing rates and risk factors, informing prognosis and follow-up decisions.

What the Research Found

This retrospective case series evaluated 100 adolescent athletes with MRI-confirmed spondylolysis who underwent 3 months of nonoperative treatment, with follow-up CT imaging to assess healing.

Key Findings:

  • 93% of fractures demonstrated partial or complete radiographic healing at 3 months
  • Only 7% showed no healing
  • No significant differences in healing based on:
    • Age
    • Sex
  • All non-healed cases were bilateral fractures, compared with 35.5% bilateral involvement in healed cases

Most common injury grade was grade 2 (64%)

Clinical Takeaways

    • Recognize that approximately 9 out of 10 adolescent spondylolysis cases heal with nonoperative management within 3 months
    • Be aware that bilateral fractures may signal higher risk of non-healing
    • Consider that age and sex may not be as predictive of healing as previously assumed
    • Use imaging selectively, as high healing rates may support clinical decision-making without routine follow-up CT in all cases
    • Monitor patients with bilateral involvement more closely, as they may require modified management or extended recovery

Where Collaborative Spine Care May Support This

Conservative spine care—including activity modification, rehabilitation, and manual therapy approaches—may support recovery in adolescent athletes by addressing load management, movement patterns, and symptom control during the healing process.

Reference

Zeller NP, Banfield NF, Stone McGaver R, Cole RP, Dawson CA. A multivariate analysis of radiographic healing in pediatric athletes diagnosed with spondylolysis. Orthop J Sports Med. 2026;14(1).
DOI: http://dx.doi.org/10.1177/23259671251395322
PubMed: https://pubmed.ncbi.nlm.nih.gov/41552621/