Lumbar Spondylolysis in Children & Adolescents New York City| Dr. Zeeshan Sardar

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Director, Quality & Patient Safety (QPS) – Och Spine Hospital
Medical Director, Spine Unit – Och Spine Hospital
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University
Och Spine Hospital • New York, NY

Spondylolysis is one of the most common causes of lower back pain in young athletes. It is a stress fracture of the pars interarticularis — a small but structurally critical bridge of bone in the posterior arch of the lumbar vertebra — caused by repetitive hyperextension loading. With appropriate diagnosis, rest, and rehabilitation, the majority of young athletes heal and return to full sporting activity.

WHAT IS SPONDYLOLYSIS?

The pars interarticularis connects the superior and inferior articular facets of each vertebra. During repetitive lumbar hyperextension — the characteristic motion of gymnastics, diving, throwing sports, football blocking, and dance — this small bony bridge is subjected to cyclic compressive and shear forces that can produce a fatigue fracture. L5 is the most commonly affected level, followed by L4. Spondylolysis is found in approximately 6% of the general population but is significantly more common in young athletes who perform repeated lumbar hyperextension.

SYMPTOMS

  • Low back pain — typically insidious onset, activity-related, worse with back extension; usually one-sided, located in the lower back just above the buttocks
  • Pain with single-leg hyperextension test — leaning backward while standing on one leg reproduces pain on the affected side; a clinically useful screening test
  • Hamstring tightness — common, particularly when spondylolysis has progressed to spondylolisthesis

DIAGNOSIS

MRI is the preferred initial imaging — it detects early stress reactions (bone marrow edema) before the fracture is complete, allowing earlier treatment and the best chance of healing. CT provides the best visualization of an established pars defect and is used when MRI is inconclusive or when surgical planning is required. X-rays may show the pars defect but are often normal in early stress fractures.

STAGES

  • Early stress reaction — bone marrow edema without cortical fracture; the best stage for healing; complete rest and bracing can result in full resolution
  • Progressive stress fracture — cortical fracture developing; healing still possible with appropriate treatment
  • Established pseudarthrosis — chronic nonunion with fibrous tissue filling the defect; healing is less likely but symptoms can still resolve

NON-SURGICAL TREATMENT

  • Activity restriction — cessation of the aggravating sport for 3–6 months depending on stage of injury
  • Bracing — a rigid lumbosacral brace reduces hyperextension loading and promotes healing; worn full-time except for bathing for 3 months in most protocols
  • Physical therapy — core stabilization exercises, hip strengthening, and hamstring flexibility; begun after the acute phase resolves
  • Gradual return to sport — guided by symptom resolution and, in some cases, imaging confirmation of healing

WHEN IS SURGERY INDICATED?

Surgery is rarely needed but may be appropriate when conservative treatment has failed after a full course (minimum 6 months), or when spondylolysis has progressed to spondylolisthesis requiring surgical treatment. Direct pars repair — placing a screw or tension band directly across the pars defect — is an option in selected patients with an isolated, well-defined pars defect without disc degeneration or slip, allowing preservation of motion at the affected level.

FREQUENTLY ASKED QUESTIONS

Will my child fully heal from this?

The majority of young athletes heal with appropriate rest and bracing, especially when caught at the early stress-reaction stage. Even when the bone doesn’t fully heal, symptoms can still resolve with treatment.

How long until my child can return to their sport?

Most protocols involve 3 to 6 months of activity restriction and bracing before a gradual, symptom-guided return to sport.

Does this always show up on an X-ray?

No. Early stress fractures are often invisible on X-ray. MRI is preferred for initial diagnosis because it detects the earliest stage, before a visible fracture line develops.

Will my child need surgery?

Surgery is rarely needed. It’s considered only after a full course of conservative treatment has failed, or if the condition progresses to spondylolisthesis requiring surgical stabilization.

Can this happen on both sides of the spine?

Yes, bilateral pars defects can occur and carry a higher risk of progressing to spondylolisthesis than a one-sided defect.

WHY CHOOSE DR. SARDAR

Dr. Sardar treats spondylolysis in young athletes from age 10 through skeletal maturity. He works with sports medicine physicians and physical therapists to optimize non-surgical management and return-to-sport timelines, and performs both direct pars repair and fusion for the small minority of patients who require surgery.

This page is for educational purposes only and does not constitute individualized medical advice.

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