Elsevier

Spine Deformity

Volume 3, Issue 1, January 2015, Pages 30-44
Spine Deformity

Systematic Review
Current Evidence Regarding the Surgical and Nonsurgical Treatment of Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence-Based Medicine Committee

https://doi.org/10.1016/j.jspd.2014.06.004Get rights and content

Abstract

Study Design

Structured literature review.

Objectives

The Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric spondylolysis with the goal of identifying both what is really known and what research remains essential to further understanding.

Summary of Background Data

Spondylolysis is common among children and adolescents and no formal synthesis of the published literature regarding treatment has been previously performed.

Methods

A comprehensive literature search was performed. The researchers reviewed abstracts and analyzed by committee data from included studies. From 947 initial citations with abstract, 383 articles underwent full text review. The best available evidence for clinical questions regarding surgical and nonsurgical treatment was provided by 58 included studies. None of the studies were graded as level I or level II evidence. Two of the studies were graded as level III evidence. Fifty-six of the studies were graded as level IV evidence. No level V (expert opinion) studies were included in the final list.

Results

Although natural history studies suggest a benign, relatively asymptomatic course for spondylolysis in most patients, both nonsurgical and surgical treatment series suggest that a substantial number of patients present with pain and activity limitations attributed to spondylolysis. Pain resolution and return to activity are common with both nonsurgical and surgical treatment (80% to 85%, respectively). Although it is implied that most surgically treated patients have failed nonsurgical treatment, the specific treatment modalities and duration required before failure is declared are not well defined. There is insufficient evidence to know which patients will benefit from specific treatment modalities (both nonsurgical and surgical).

Conclusions

Because of the preponderance of uncontrolled case series and the lack of comparative studies, only low-quality evidence is available to guide the treatment of pediatric spondylolysis.

Introduction

The progress of published medical knowledge, changes in societal expectations, and developments in health care economics have lead medical organizations to develop evidence-based documents and products such as clinical practice guidelines, appropriate use criteria, and performance improvement modules. The initial step of each of these is a structured literature review to assess the current state of peer-reviewed evidence. The Evidence-Based Medicine Committee of the Scoliosis Research Society recently undertook a structured literature review of pediatric lumbar spondylolysis. Clinically relevant questions regarding treatment, both surgical and nonsurgical, were proposed by the committee.

Section snippets

Methods

A working definition for lumbar spondylolysis was developed by group consensus. Relevant clinical questions were proposed and refined by group consensus.

Working definition

Lumbar spondylolysis refers to a bony defect (or stress reaction) occurring in the lumbar pars interarticularis.

How do various treatments compare with the natural history of spondylolysis?

There is insufficient evidence in the literature to answer this question. No study compared treatment with the natural history of spondylolysis. No study directly compared the various nonsurgical treatments. The only comparative studies identified compared the results of 2 surgical techniques [1], [2]. Although natural history studies suggest a benign, relatively asymptomatic course

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    Author disclosures: CHC (none); CGTL (none); RSB (none); JMB (none); DCB (none); SSH (none); BSHL (none); DWP (none); JSS (none); JOS (none).

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