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Purpose of Review <p>This narrative review synthesizes current evidence regarding the pathophysiology, diagnosis, management, and return-to-play (RTP) considerations for spondylolysis in adolescent athletes. We sought to clarify optimal imaging strategies, evaluate conservative and surgical treatment outcomes, and examine evidence guiding RTP decisions.</p> Recent Findings <p>MRI has emerged as the preferred diagnostic modality for early detection of pars interarticularis bone stress injuries, reducing reliance on CT and SPECT. Early initiation of physical therapy and criterion-based rehabilitation models demonstrate high rates of symptom resolution and RTP. Evidence supporting routine lumbar bracing remains inconclusive. Radiographic healing does not reliably predict functional recovery.</p> Summary <p>Most adolescent athletes with spondylolysis achieve successful RTP with nonoperative, rehabilitation-focused management. Early diagnosis and timely, progressive loading strategies improve outcomes. Future research should focus on randomized trials evaluating bracing, rehabilitation timing, and standardized RTP criteria to optimize care.</p>

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Spondylolysis in Athletes: A Narrative Review of Pathophysiology, Diagnosis, and Management

  • 期刊论文

  • 发表日期：

    2026年7月4日

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  • Michelle E. Flohr Rozanski,
  • Gabrielle N. Avancena,
  • Ayahiro D. Takashima,
  • Rosa M. Pasculli

摘要

Purpose of Review

This narrative review synthesizes current evidence regarding the pathophysiology, diagnosis, management, and return-to-play (RTP) considerations for spondylolysis in adolescent athletes. We sought to clarify optimal imaging strategies, evaluate conservative and surgical treatment outcomes, and examine evidence guiding RTP decisions.

Recent Findings

MRI has emerged as the preferred diagnostic modality for early detection of pars interarticularis bone stress injuries, reducing reliance on CT and SPECT. Early initiation of physical therapy and criterion-based rehabilitation models demonstrate high rates of symptom resolution and RTP. Evidence supporting routine lumbar bracing remains inconclusive. Radiographic healing does not reliably predict functional recovery.

Summary

Most adolescent athletes with spondylolysis achieve successful RTP with nonoperative, rehabilitation-focused management. Early diagnosis and timely, progressive loading strategies improve outcomes. Future research should focus on randomized trials evaluating bracing, rehabilitation timing, and standardized RTP criteria to optimize care.