Spondylolysis and spondylolisthesis: A review of the literature.

Spondylolysis is a common diagnosis with a high prevalence in children and adolescents complaining of low back pain. It may be caused by either a defect or fracture of the pars interarticularis due to mechanical stress. Depending on the severity of the spondylolysis and symptoms associated it may be treated either conservatively or surgically, both of which have shown significant success. Conservative treatments such as bracing and decreased activity have been shown to be most effective with patients who have early diagnosis and treatment. Low-intensity pulsed ultrasound (LIPUS) in addition to conservative treatment appears to be very promising for achieving a higher rate of bony union. LIPUS requires more supporting studies, but may prove to become a standard of care in the future. Surgery may be required if conservative treatment, for at least six months, failed to give sustained pain relief for the activities of daily living. Based on studies performed on each of the major surgical treatments we suggest the use of the pedicle screw hook technique and the pedicle screw rod technique due to low rates of hardware failure, increased maintenance of mobility, and lack of a postoperative bracing requirement.