Clinical Examination, Spondylolysis and Adolescent Athletes

Abstract

Symptomatic spondylolysis is a stress reaction caused by microtrauma during physical exercise, an imaging diagnostic subgroup of Adolescent Low Back Pain (ALBP), found in adolescent athletes. Early diagnosis increases the possibility of healing. Thus, it is important to divide ALBP into subgroups. The aim of this study was to evaluate clinical tests that can distinguish symptomatic spondylolysis from other forms of ALBP in order to facilitate early referral for diagnostic imaging. The investigation subjects were a prospective case series with a control group, 25 subjects with ALBP and 13 subjects that had no history of LBP. The 2 groups were examined using the same clinical protocol. MRI of the whole lumbar spine was performed in both the case and control groups and CT investigations of the L4 and L5 vertebrae were performed in the case group. Significant differences between the 2 groups were found in 8 of our clinical tests. No clinical test, alone or in combination, could distinguish between spondylolysis and other forms of ALBP. As 88% of the subjects in the case group had MRI findings and almost 50% had spondylolysis, MRI should be performed at an early age in young athletes with ALBP.

Key words

low back pain - stress fracture - stress reaction

• References

• 1 Baranto A, Hellström M, Nyman R, Lundin O, Swärd L. Back pain and degenerative abnormalities in the spine of young elite divers: a 5-year follow-up magnetic resonance imaging study. Knee Surg Sports Traumatol Arthrosc 2006; 14: 907-914
• 2 Burton AK, Clarke RD, McClune TD, Tillotson KM. The natural history of low back pain in adolescents. Spine (Phila Pa 1976) 1996; 21: 2323-2328
• 3 Dankaerts W, O’Sullivan P. The validity of O’Sullivan’s classification system (CS) for a sub-group of NS-CLBP with motor control impairment (MCI). Overview of a series of studies and review of the literature. Man Ther 2011; 16: 9-14
• 4 Debnath UK, Harshavardhana N, Scammell BE, Freeman BJC. Lumbar pars injury or spondylolysis – diagnosis and management. Orthop Trauma 2009; 23: 109-116
• 5 Fujii K, Katoh S, Sairyo K, Ikata T. Union of defects in the pars interarticularis of the lumbar spine in children and adolescents. The radiological outcome after conservative treatment. J Bone Joint Surg Br 2004; 86: 225-231
• 6 Grieve GP. ed. Modern manual therapy of the vertebral column. Edinburgh: Churchill Livingstone; 2^nd edition 1994
• 7 Harriss DJ, Atkinson G. Update – ethical standards in sport and exercise science research. Int J Sports Med 2011; 32: 819-821
• 8 Hollenberg GM, Beattie PF. Stress reactions of the lumbar pars interarticularis: the development of a new MRI classification system. Spine 2002; 27: 181-186
• 9 Hu SS, Tribus CB, Diab M, Ghanayem AJ. Spondylolisthesis and spondylolysis. J Bone Joint Surg Am 2008; 90: 656-671
• 10 Kaltenborn F. Manual mobilization of the joints. Volume II. The Spine 5^th edition 2009. Norli, Oslo, Norway:
• 11 Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G, Jørgensen K. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 1987; 18: 233-237
• 12 Kujala UM, Taimela S, Erkintalo M, Salminen JJ, Kaprio J. Low-back pain in adolescent athletes. Med Sci Sports Exerc 1996; 28: 165-170
• 13 Kujala UM, Kinnunen J, Helenius P, Orava S, Taavitsainen M, Karaharju E. Prolonged low-back pain in young athletes: a prospective case series study of findings and prognosis. Eur Spine J 1999; 8: 480-484
• 14 Lundin DA, Wiseman D, Ellenbogen RG, Shaffrey CI. Direct repair of the pars interarticularis for spondylolysis and spondylolisthesis. Pediatr Neurosurg 2003; 39: 195-200
• 15 Masci L, Pike J, Malara F, Phillips B, Bennell K, Brukner P. Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis. Br J Sports Med 2006; 40: 940-946
• 16 Micheli LJ, Wood R. Back pain in young athletes. Significant differences from adults in cause and patterns. Arch Pediatr Adolesc Med 1995; 149: 15-18
• 17 Morita T, Ikata T, Katoh S, Miyake R. Lumbar spondylolysis in children and adolescents. J Bone Joint Surg Br 1995; 77: 620-625
• 18 Patel AT, Ogle AA. Diagnosis and management of acute low back pain. Am Fam Physician 2000; 61: 1779-1790
• 19 Paatelma M, Karvonen E, Heinonen A. Inter- and intra-tester reliability of selected clinical tests in examining patients with early phase lumbar spine and sacroiliac joint pain and dysfunction. Adv Physiother 2010; 12: 74-80
• 20 Ralston S, Weir M. Suspecting lumbar spondylolysis in adolescent low back pain. Clin Pediatr (Phila) 1998; 37: 287-293
• 21 Salminen JJ, Erkintalo MO, Pentti J, Oksanen A. Recurrent low back pain and early disc degeneration in the young. Spine 1999; 24: 1316-1321
• 22 Saraste H. Symptoms in relation to the level of spondylolysis. Int Orthop 1986; 10: 183-185
• 23 Sonne-Holm S, Jacobsen S. Lumbar spondylolysis: A lifelong dynamic condition? A cross sectional survey of 4.151 adults. Eur Spine J 2007; 16: 821-828
• 24 Standaert CJ, Herring SA. Spondylolysis: a critical review. Br J Sports Med 2000; 34: 415-422
• 25 Steinberg EL, Luger E, Arbel R, Menachem A, Dekel S. A comparative roentgenographic analysis of the lumbar spine in male army recruits with and without lower back pain. Clin Radiol 2003; 58: 985-989