![]() Caucasian males are most commonly affected with a prevalence of 6.4% African American males, Caucasian females, and African American females are also notable with prevalences of 2.8%, 2.3%, and 1.1%, respectively. 21,22 In the United States, race and genetic sex seem to also play a role in the spondylolysis prevalence rate. However, since adolescent female participation in competitive sports has increased, especially in female-dominated sports such as gymnastics, the prevalence of spondylolysis in females has increased four-fold. 19,20 Historically, spondylolysis was thought to occur two to three times as often in males than females. Studies have shown that up to 30% of young athletes experience low back pain compared to 18% in their non-athlete counterparts. 12,13,18 Additionally, adolescent athletes are at increased risk of suffering from low back pain, especially in spinal extension-intensive sports such as gymnastics. Although spondylolysis is less common in children, it has been shown to be the leading cause of low back pain in adolescent athletes, explaining nearly 47% of low back pain in this population. 13,16,17 This is postulated to be due to weight bearing as a risk factor for spondylolysis, since virtually no cases of spondylolysis has been reported in non-ambulatory patients. 14,15 It is rare in children, with incidence increasing in proportion to age up until the age of 18. Spondylolysis is a relatively common condition in adults, affecting between 6-8% of the general adult population. The purpose of this manuscript is to provide a detailed review of spondylolysis regarding its epidemiology, pathophysiology, risk factors, clinical presentation, diagnostic criteria, and current treatment guidelines and options. If pain persists, treatment may be necessary. 12,13 Although spondylolysis is often asymptomatic, a comprehensive physical exam in addition to imaging is often helpful in confirming the diagnosis. ![]() However, back pain is uncommon in children and adolescents, and presence of low back complaints may indicate further workup for spondylolysis in children, especially in higher-risk populations such as young athletes. 2,11 When symptomatic, spondylolysis often presents as low back pain and is more commonly observed in adults. 10 Spondylolysis is often asymptomatic and found incidentally on imaging. 4,8,9 The incidence of spondylosis increases with age until patients reach an age of 18 incidence plateaus at this point. Although cases of cervical spondylolysis have been reported, it is much more prevalent in the lumbar vertebrae. 7 However, bilateral lesions may potentially result in spondylolisthesis, which is the anterior, lateral, or posterior displacement of the vertebral body in relation to the sub-adjacent vertebra. 5,6 As reported by Fuji et al., patients with a unilateral lesion at the 4 th lumbar vertebrae that are detected early are predicted to have complete bony healing. When unilateral, there is an increased chance of bony healing compared to bilateral lesions. 3,4 The defect can occur unilaterally or bilaterally. 1,2 A lesion of the pars interarticularis can be bridged by osseous, fibrous, or cartilaginous material resulting in a chronic non-union. Spondylolysis is a bony defect in the pars interarticularis, which represents the junction of the superior articular process, inferior articular process, lamina, and pedicle of the vertebra.
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