{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:52:59Z","timestamp":1785426779139,"version":"3.56.0"},"reference-count":50,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Spondylolysis is a stress fracture of the pars interarticularis, most common in adolescents and athletes involved in sports requiring repetitive spinal loading, extension, and rotation. The condition is often underdiagnosed due to delays in presentation and diagnosis, particularly among non-orthopedic providers. Aims: This review aims to summarize the current understanding of spondylolysis, focusing on its etiology, diagnosis, management strategies, and identify gaps in research for future exploration. Methods: A structured literature search was conducted in PubMed to identify studies relevant to pediatric and adolescent spondylolysis, spondylosis, and spondylolisthesis, particularly in the context of athletic injuries. The initial search yielded 143 citations. Applying filters for English language publications within the past five years reduced this to 125 citations. Limiting to populations that were aged 18 years and under returned 50 studies. After screening the titles and abstracts, 12 non-specific or irrelevant articles (including letters to the editor) were excluded, leaving a final dataset of 38 articles for detailed review. In addition, foundational and landmark studies outside this window were included to provide historical and conceptual context, bringing the total evidence base to 50 papers. Findings: Spondylolysis most commonly affects the L5 vertebra, with a higher incidence in male athletes. Conservative treatments like physical therapy and bracing are effective, especially when initiated early. However, the efficacy of bracing remains debated, with limited evidence on long-term clinical benefits. Surgical intervention is considered for severe or non-responsive cases. Diagnostic methods, including CT and MRI, are preferred, with emerging techniques like ultrasound showing potential for non-ionizing, cost-effective, early detection. Implications: Early diagnosis and treatment are crucial for preventing progression to spondylolisthesis. While conservative treatments often yield favorable outcomes, more research is needed to compare the effectiveness of bracing and pharmacological interventions. Future studies should focus on long-term outcomes, cost-effective, non-ionizing diagnostic methods, and the role of emerging therapies like regenerative medicine. A multi-disciplinary approach is vital for optimal patient care, particularly in young athletes.<\/jats:p>","DOI":"10.3390\/ijerph23020153","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T12:41:16Z","timestamp":1769431276000},"page":"153","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Spondylolysis: A Narrative Review of Etiology, Diagnosis, and Management"],"prefix":"10.3390","volume":"23","author":[{"given":"Vanessa","family":"Madden","sequence":"first","affiliation":[{"name":"Thomas Sports and Regenerative Orthopedics (TSARO), Battle Creek, MI 49014, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2611-3724","authenticated-orcid":false,"given":"Adam","family":"Ayoub","sequence":"additional","affiliation":[{"name":"Homer Stryker Medical School, Western Michigan University, Kalamazoo, MI 49008, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Thomas","sequence":"additional","affiliation":[{"name":"Thomas Sports and Regenerative Orthopedics (TSARO), Battle Creek, MI 49014, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Thomas","sequence":"additional","affiliation":[{"name":"Thomas Sports and Regenerative Orthopedics (TSARO), Battle Creek, MI 49014, USA"},{"name":"Homer Stryker Medical School, Western Michigan University, Kalamazoo, MI 49008, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/MOP.0000000000000706","article-title":"Spondylolysis 2019 update","volume":"31","author":"Berger","year":"2019","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Asai, R., Tatsumura, M., Gamada, H., Okuwaki, S., Eto, F., Nagashima, K., Takeuchi, Y., Funayama, T., Mammoto, T., and Hirano, A. (2023). Epidemiological differences between the sexes in adolescent patients with lumbar spondylolysis: A single-institution experience in Japan. BMC Musculoskelet. Disord., 24.","DOI":"10.1186\/s12891-023-06679-1"},{"key":"ref_3","first-page":"37470","article-title":"Spondylolysis","volume":"14","author":"Li","year":"2022","journal-title":"Orthop. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"699","DOI":"10.2106\/00004623-198466050-00008","article-title":"The natural history of spondylolysis and spondylolisthesis","volume":"66","author":"Fredrickson","year":"1984","journal-title":"J. Bone Jt. Surg."},{"key":"ref_5","first-page":"263","article-title":"Clinical examination, spondylolysis and adolescent athletes","volume":"34","author":"Sundell","year":"2013","journal-title":"Int. J. Sports Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jspd.2017.10.008","article-title":"Diagnosis of Spondylolysis and Spondylolisthesis Is Delayed Six Months After Seeing Nonorthopedic Providers","volume":"6","author":"Nielsen","year":"2018","journal-title":"Spine Deform."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2639","DOI":"10.1177\/03635465241264804","article-title":"Pars Interarticularis and Pedicle Stress Injuries in Young Athletes with Low Back Pain: A Retrospective Cohort Study of 902 Patients Evaluated with Magnetic Resonance Imaging","volume":"52","author":"Kriz","year":"2024","journal-title":"Am. J. Sports Med."},{"key":"ref_8","first-page":"265","article-title":"Does Direct Surgical Repair Benefit Pars Interarticularis Fracture? A Systematic Review and Meta-analysis","volume":"25","author":"Tsai","year":"2022","journal-title":"Pain Physician"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e34857","DOI":"10.1097\/MD.0000000000034857","article-title":"Incidence of lumbar spondylolysis in athletes with low back pain: A systematic evaluation and single-arm meta-analysis","volume":"102","author":"Li","year":"2023","journal-title":"Medicine"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Trefilova, V.V., Shnayder, N.A., Petrova, M.M., Kaskaeva, D.S., Tutynina, O.V., Petrov, K.V., Popova, T.E., Balberova, O.V., Medvedev, G.V., and Nasyrova, R.F. (2021). The Role of Polymorphisms in Collagen-Encoding Genes in Intervertebral Disc Degeneration. Biomolecules, 11.","DOI":"10.3390\/biom11091279"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1136\/bjsm.34.6.415","article-title":"Spondylolysis: A critical review","volume":"34","author":"Standaert","year":"2000","journal-title":"Br. J. Sports Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1016\/j.jos.2023.09.004","article-title":"Effect of lumbar lordosis angle on the development of lumbar spondylolysis in adolescent baseball players: A cross-sectional study","volume":"29","author":"Onoda","year":"2024","journal-title":"J. Orthop. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.jos.2022.10.014","article-title":"Clinical characteristics of early-stage lumbar spondylolysis detected by magnetic resonance imaging in male adolescent baseball players","volume":"29","author":"Kato","year":"2024","journal-title":"J. Orthop. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1186\/s13018-020-01910-4","article-title":"Comparison of symptomatic spondylolysis in young soccer and baseball players","volume":"15","author":"Yokoe","year":"2020","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ptsp.2020.05.009","article-title":"Development of a preliminary multivariable diagnostic prediction model for identifying active spondylolysis in young athletes with low back pain","volume":"45","author":"Therriault","year":"2020","journal-title":"Phys. Ther. Sport"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e165","DOI":"10.1097\/JSM.0000000000000920","article-title":"Is Increased Kicking Leg Iliopsoas Muscle Tightness a Predictive Factor for Developing Spondylolysis in Adolescent Male Soccer Players?","volume":"32","author":"Takei","year":"2022","journal-title":"Clin. J. Sport Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1177\/03635465221146289","article-title":"Risk Factors for Symptomatic Bilateral Lumbar Bone Stress Injury in Adolescent Soccer Players: A Prospective Cohort Study","volume":"51","author":"Tsutsui","year":"2023","journal-title":"Am. J. Sports Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3709","DOI":"10.1007\/s00586-024-08478-1","article-title":"Low back pain characteristics in adolescent patients with early-stage spondylolysis: A prospective study","volume":"33","author":"Sugiura","year":"2024","journal-title":"Eur. Spine J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"9235958","DOI":"10.1155\/2020\/9235958","article-title":"Spondylolysis in Young Athletes: An Overview Emphasizing Nonoperative Management","volume":"2020","author":"Goetzinger","year":"2020","journal-title":"J. Sports Med."},{"key":"ref_20","unstructured":"McDonald, B.T., Hanna, A., and Lucas, J.A. (2025, November 11). Spondylolysis, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK513333\/."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"412","DOI":"10.22603\/ssrr.2020-0199","article-title":"Utility of physical examination findings for predicting low-back pain in adolescent patients with early-stage spondylolysis: A retrospective comparative cohort study","volume":"5","author":"Sugiura","year":"2021","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/j.jos.2022.06.019","article-title":"Utility of ultrasonography in the diagnosis of lumbar spondylolysis in adolescent patients","volume":"28","author":"Nakashima","year":"2023","journal-title":"J. Orthop. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Achar, S., Hwang, D., Finkenstaedt, T., Malis, V., and Bae, W.C. (2023). Deep-Learning-Aided Evaluation of Spondylolysis Imaged with Ultrashort Echo Time Magnetic Resonance Imaging. Sensors, 23.","DOI":"10.3390\/s23188001"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.bjpt.2017.08.001","article-title":"Diagnosis and treatment of movement system impairment syndromes","volume":"21","author":"Sahrmann","year":"2017","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1002\/ar.1091090207","article-title":"The incidence of separate neural arch and coincident bone variations; a survey of 4,200 skeletons","volume":"109","author":"Roche","year":"1951","journal-title":"Anat. Rec."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1007\/s00586-017-5339-5","article-title":"The prevalence of lumbar spondylolysis in young children: A retrospective analysis using CT","volume":"27","author":"Lemoine","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1002\/pmrj.12756","article-title":"The use of bracing in the management of lumbar spondylolysis","volume":"14","author":"Ibiebele","year":"2022","journal-title":"PM R"},{"key":"ref_28","first-page":"610","article-title":"Conservative treatment for pediatric lumbar spondylolysis to achieve bone healing using a hard brace: What type and how long? Clinical article","volume":"16","author":"Sairyo","year":"2012","journal-title":"J. Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"653","DOI":"10.3928\/0147-7447-20020601-15","article-title":"Spondylolysis: Returning the athlete to sports participation with brace treatment","volume":"25","author":"Zurakowski","year":"2002","journal-title":"Orthopedics"},{"key":"ref_30","first-page":"s26","article-title":"Chronic Nerve Root Injury in Pediatric Patients With Chronic Lumbar Stress Fractures: A Retrospective Review","volume":"76","author":"Tessendorf","year":"2023","journal-title":"South Dak. Med."},{"key":"ref_31","unstructured":"Pruthi, S. (2025, November 11). Cervical Spondylosis Can Cause Neck Pain-Cervical Spondylosis\u2014Diagnosis & Treatment. Mayo Clinic. Available online: https:\/\/www.mayoclinic.org\/diseases-conditions\/cervical-spondylosis\/diagnosis-treatment\/drc-20370792."},{"key":"ref_32","first-page":"18","article-title":"Increased risk for stress fractures and delayed healing with NSAID receipt, U.S. Armed Forces, 2014\u20132018","volume":"27","author":"Fedgo","year":"2020","journal-title":"MSMR"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.jbmt.2024.02.005","article-title":"Are trunk muscle sizes different between acute lumbar spondylolysis and nonspecific low back pain?","volume":"39","author":"Aoyagi","year":"2024","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1177\/1941738113480936","article-title":"Nonoperative Treatment in Lumbar Spondylolysis and Spondylolisthesis","volume":"5","author":"Garet","year":"2013","journal-title":"Sports Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"540","DOI":"10.22603\/ssrr.2021-0242","article-title":"Rates of Return to Sports and Recurrence in Pediatric Athletes after Conservative Treatment for Lumbar Spondylolysis","volume":"6","author":"Kasamasu","year":"2022","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.jbmt.2021.07.011","article-title":"Physical characteristics of patients with symptomatic lumbar spondylolysis who have recurrent low back pain after returning to sports","volume":"28","author":"Yamazaki","year":"2021","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1097\/BRS.0000000000004849","article-title":"Rate and Duration of Bone Union for Conservative Treatment in Pediatric Lumbar Spondylolysis","volume":"49","author":"Kuroshima","year":"2024","journal-title":"Spine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.jos.2021.01.002","article-title":"Union evaluation of lumbar spondylolysis using MRI and CT in adolescents treated conservatively","volume":"27","author":"Tatsumura","year":"2022","journal-title":"J. Orthop. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jocn.2021.08.018","article-title":"Conservative treatment for lumbar spondylolysis in children of elementary school age","volume":"92","author":"Gamada","year":"2021","journal-title":"J. Clin. Neurosci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1097\/BRS.0000000000004976","article-title":"Correlation of Radiographic Healing on Advanced Imaging in Young Adults and Adolescents With Symptomatic Spondylolysis Before and After Treatment: A Retrospective Study","volume":"49","author":"Gauthier","year":"2024","journal-title":"Spine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2866","DOI":"10.1177\/03635465241270293","article-title":"Risk Factors for Nonunion After Nonoperative Treatment for Pediatric Lumbar Spondylolysis: A Retrospective Case-Control Study","volume":"52","author":"Kuroshima","year":"2024","journal-title":"Am. J. Sports Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1186\/s13018-023-03861-y","article-title":"Main and contralateral side stages of lesion affected bone union in the conservative treatment of adolescent lumbar spondylolysis: A multivariable analysis of 217 patients and 298 lesions in a retrospective cohort study","volume":"18","author":"Gamada","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_43","first-page":"126","article-title":"Impact of corset bracing on 3D spine kinematics during ADL in children with Spondylolysis","volume":"Volume 280","author":"Hays","year":"2021","journal-title":"Research into Spinal Deformities 9"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"107920","DOI":"10.1016\/j.clineuro.2023.107920","article-title":"Endoscopic-assisted fusion for lumbar pars fracture repair in an adolescent patient","volume":"233","author":"Lu","year":"2023","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1227\/neu.0000000000002210","article-title":"Percutaneous Direct Pars Repair in Young Athletes","volume":"92","author":"Jamshidi","year":"2023","journal-title":"Neurosurgery"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1016\/j.spinee.2022.04.011","article-title":"Management of lumbar spondylolysis in the adolescent athlete: A review of over 200 cases","volume":"22","author":"Choi","year":"2022","journal-title":"Spine J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1080\/10669817.2022.2056310","article-title":"Developing clinical algorithm for identifying acute lumbar spondylolysis in elementary school children\u2014Classification and regression tree analysis","volume":"30","author":"Aoyagi","year":"2022","journal-title":"J. Man. Manip. Ther."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1249\/JSR.0000000000001008","article-title":"Clinical Practice Patterns of Isthmic Spondylolysis in Young Athletes: A Survey of Pediatric Research in Sports Medicine Members","volume":"21","author":"Hollabaugh","year":"2022","journal-title":"Curr. Sports Med. Rep."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.ptsp.2021.08.009","article-title":"Immediate functional progression program in adolescent athletes with a spondylolysis","volume":"52","author":"Selhorst","year":"2021","journal-title":"Phys. Ther. Sport"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/j.jsams.2024.05.004","article-title":"Adolescent athlete low back pain diagnoses, characteristics, and management: A retrospective chart review","volume":"27","author":"Wall","year":"2024","journal-title":"J. Sci. Med. Sport"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/2\/153\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T12:42:25Z","timestamp":1769431345000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/2\/153"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":50,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["ijerph23020153"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23020153","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]}}}