Spondylolysis in Adolescent Athletes: Differences Based on Sex and Timing of Presentation

Abstract Background: Spondylolysis is a common cause of spine pain in adolescent athletes, but little is known about possible differences in cases of this process based on sex of the patient or timing of presentation (ToP). This descriptive study aims to determine whether significant differences exist. Methods: Retrospective chart review of all patients ages 10-20 years diagnosed with spondylolysis over a 17-year period. Demographic, injury history, physical exam findings, diagnostic imaging findings, treatments, return to sport vs. surgical consultation and DoC information was collected and analyzed. Results: Females and early presenters (EPs, <90 days) with spondylolysis are significantly younger and are more likely to report pain with spine range of motion compared to males and LPs. Males are more likely to report an acute onset of pain and leg weakness. Stork testing has a higher sensitivity in females. LPs show more x-ray findings than EPs and females are more likely to demonstrate SBO on x-ray. MRI has low sensitivity in both sexes. All subgroups show shortened DoC if treated without formal physical therapy, or lumbar bracing. LPs show a longer DoC are more likely to be referred for surgical consultation than EPs. Conclusions: Several statistically significant differences in presentation, exam findings, diagnostic imaging findings, and DoC in patients with spondylolysis exist based on patient sex and ToP.