A Multivariate Analysis of Radiographic Healing in Pediatric Athletes Diagnosed With Spondylolysis.

Background: Spondylolysis is commonly seen in adolescent athletes with lumbar pain after acute or repetitive low back hyperextension. Nonoperative management and rest often lead to symptom resolution and return to sport in acute injuries. However, follow-up imaging confirming radiographic healing is rarely utilized. Purpose/Hypothesis: The purpose of this study was to investigate the relationship between age, sex, and radiographic healing in pediatric athletic patients with spondylolysis after nonoperative treatment. It was hypothesized that younger athletes would have better healing rates as older patients are closer to the end of bony growth. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was conducted of adolescent cases of spondylolysis treated by a single physician between September 1, 2022, and May 1, 2024. Patients included were <19 years of age, had a diagnosis of spondylosis as confirmed by magnetic resonance imaging with limited computed tomography (CT) imaging, and had a 3-month follow-up limited CT study. Patients diagnosed with chronic spondylosis or spondylolisthesis or treated surgically were excluded. Data collection included sex, date of birth, sports participation, date of injury and initial visit, fracture Hollenberg grade, fracture laterality, and fracture spinal level. Initial and 3-month follow-up limited CT imaging reports were also reviewed to evaluate healing status. Results: A total of 100 patients were included in the final analysis. The mean age at the time of injury was 15.0 years (range, 9-18 years). The most common spondylosis fracture grade seen was grade 2 (64%) across all age groups. After 3 months of nonoperative treatment, 93 fractures demonstrated partial or complete healing on follow-up imaging, whereas 7 fractures demonstrated no healing. No differences in healing rates were observed between the age groups or sexes. Notably, all the nonhealed fractures were bilateral, compared with 33 (35.5%) of the healed fractures (P = .001). Conclusion: The vast majority (93%) of acute adolescent spondylosis cases demonstrated radiographic healing after 3 months of nonoperative treatment.