Management of symptomatic lumbar spondylolysis without listhesis in adolescent athletes represents a unique challenge for the treating physician. In the general population, the majority of cases can be successfully treated with rest and conservative management. Surgical intervention is indicated only for those few individuals who have failed a prolonged (>6 months) trial of conservative management.

Recently, some studies have reported on the rate of return to play (RTP) after both conservative and surgical management of isthmic spondylolysis without listhesis in high-level athletes. In this meta-analysis, we evaluate the recently published literature regarding the efficacy of conservative and operative management about the rate of RTP. Back pain due to spondylolysis without listhesis in the adolescent athlete is a relatively common problem.

Epidemiological studies have demonstrated an overall incidence of 3% to 6% in the general population, while the young athlete has been shown to carry a much higher incidence of 15%. Nonsurgical management is the mainstay of treatment for patients with symptomatic spondylolysis.  However, in the sidelined adolescent elite athlete, conflicting motives exist the desire for expeditious RTP as well as the need to heal the pain generating pars defect, which necessitates a hiatus from sporting activity.

These often conflicting goals have led to advances in the surgical treatment of symptomatic spondylolysis in those who fail conservative treatment in this demographic. Young athletes may have a lower threshold to complete lengthy periods of rest from activity, physical therapy, and core strengthening due to their desire to RTP quickly. To move RTP expeditiously at a high level of performance, the athlete and parents of the athlete may urge surgeons to pursue a more aggressive approach leading to an earlier abandonment of nonoperative management.

Low back pain in the adolescent athlete is a common problem. When the aetiology is spondylolysis without listhesis, several treatment options exist. Nonoperative treatment consisting of activity restriction, rest, and physical therapy with or without adjunctive bracing is the gold standard; however, not all pars defects heal with this management and some patients remain symptomatic.

These patients may benefit from one of several direct pars repair techniques. The results of this study suggest that both nonoperative and operative treatments for spondylolysis results in high rates of RTP, though it should be emphasized that all patients in all included studies did undergo primary nonoperative treatment. Surgeons should employ nonoperative treatment in young athletes with surgical intervention reserved only for those who fail a lengthy dedicated course of activity restriction and physical therapy.