Surgical management of spondylolysis and spondylolisthesis in athletes: indications and return to play.

Symptomatic isthmic spondylolisthesis is a common problem in the competitive athlete. Presence of this disorder is recognized easily with imaging studies, although a certain index of suspicion is necessary in the face of normal x-rays. Bone scan, CT scan, and MRI may all play a role in diagnosis. Management of this condition, on the other hand, can be more challenging. There are no high level evidence studies with specific recommendations for bracing, rehab, or surgery. Most athletes successfully return to competition with nonoperative treatment. For those that fail, a pars repair or a fusion are potential options. There are a myriad of techniques advocated for both, and no head to head study has ever proven superiority. Even with fusion, many individuals can return to sports after several months of structured rehab, although a significant number of athletes will fail to resume their pre-injury level of activity.