Abstract
Background:
Sport-related, isthmic spondylolysis is a common cause of low back pain in adolescent athletes (1). While previous studies have reported prevalence rates, there is limited evidence of the factors that contribute to its occurrence. The Spine/Spondylolysis Research Interest Group of PRiSM conducted a systematic review to estimate the prevalence of isthmic spondylolysis in athletes aged 10-19 years and sought to investigate the association between prevalence and various factors including sex, age, race, ethnicity, geographic location, sport type, year of publication, imaging modalities, and treatment methods.
Hypothesis:
The overall prevalence of isthmic spondylolysis in young athletes is approximately 30%.
Methods:
A systematic review was conducted in PubMed, Elsevier Embase, EBSCOhost SportDiscus, and the Wiley Cochrane Central Register of Controlled Trials, covering studies published from inception to March 2024. Keywords included “spondylolysis”, “pars interarticularis”, and a complete list of specific sports. All studies reporting the prevalence of isthmic spondylolysis in athletes aged 10-19 years, including cross-sectional and cohort studies were considered, while case reports, case series, case-control and narrative reviews were excluded. Two reviewers independently screened studies for eligibility and extracted data. Data were synthesized through meta-analysis using random-effects models, with the calculations of prevalence and its 95% confidence interval (CI).
Results:
A total of 1864 studies were identified, and 93 studies met the inclusion criteria. The overall prevalence of sport-related isthmic spondylolysis was found to be 28% (95% CI: 24-32%). Subgroup analyses indicated higher prevalence rates in baseball [45% (95% CI: 30-60%)], hockey [43% (95% CI: 27-59%)], track & field [36% (95% CI: 19-52%)], and cricket [35% (95% CI: 23-47%)] (Figure 1). Male athletes exhibited a higher prevalence compared to females [33% (95% CI: 27-39%) vs. 15% (95% CI: 11-20%)]. The mean age for isthmic spondylolysis was 15.4 years (95% CI: 13.97-16.88). Countries with the highest prevalence include Japan [36% (95% CI: 29-42%)], New Zealand [32% (95% CI: 22-42%)], United Kingdom [31% (95% CI: 17-44%)], and the United States [30% (95% CI: 22-39%)]. Recent studies suggest an increasing prevalence over time.
Conclusion:
This systematic review represents the largest known study reporting the overall prevalence of isthmic spondylolysis in adolescent athletes, highlighting the influence of factors such as sport type, sex, age, country, and year of publication. The findings suggest the need for clinicians to have a high index of suspicion in young athletes with low back pain. Future research should explore long-term outcomes and the effectiveness of different treatments.
