An alternative goal of conservative treatment in elite pediatric athletes with lumbar spondylolysis: A case report and literature review

The main conservative treatment strategies for lumbar spondylolysis are bone healing and pain management. Bone healing requires cessation of sports, which may be difficult for pediatric athletes. A 15-year-old female athlete had bilateral L2 spondylolysis (right: very-early stage; left: progressive). Radiographs suggested vertebral maturity. Although bone healing could be expected on both sides, we aimed for continuation of play because she was a candidate for a national-level team attending an international competition. We implemented strenuous athletic rehabilitation based on joint-by-joint theory to reduce lumbar spine loading. A pars fracture led to pseudoarthrosis, but she continued playing and participated in the competition without problem. In pediatric patients with spondylolysis and low risk of slippage, treatment aimed at continuation of play and pain management rather than bone healing may be considered, particularly in elite athletes. Strenuous athletic rehabilitation, including thoracic spine mobilization, is essential in such cases.