The Prevalence of Spondylolysis in the Italian Elite Young Athlete

Objective: The objective of the current retrospective study was to explore the cause-and-effect relationship between sports and spondylolysis in order to identify which sports ar more prone to its of progression of the pathology.
Methods: 1704 consecutive Olympic athletes’ radiographic material of the lumbar-sacral spine was retropspectively analyzed. The athletes included in the study were registered with the Italian National Olympic Committee (CONI) and they were selected between January 2008 and December 2018. Participants were aged between 12 and 27 years old (average: 19.5). Types of sports played by the athletes of the sample were diving, weightlifting, wrestling, gymnastics, track and field.
Results: 16.37% (n=279) of the sample had evidence of isthmic degenerative changes, 15.20% (n=259) had evidence of isthmic spondylolysis, of which 37.84% (n=98) was associated with spondylolisthesis. The prevalence of spondylolysis was equal to 62.43% in diving, 36.20% in weightlifting, 34.78% in wrestling, 31.68% in gymnastics, 25% in track and field. The prevalence of isthmic degenerative alterations was equal to 81.24% in diving, 44.82% in weightlifting, 39.52% in wrestling, 37.33% in gymnastics, 25.62% in track and field. The location of the lesions was the lumbar region in all cases, predominantly L5 (81.53%).
Conclusion: Wrestling, weightlifting, and diving were categorized as high-risk sports. Preventive measures are crucial, including lumbar-sacral radiographic screening in sports medical programs for high-risk athletes to ensure proper training and minimize the risk of spondylolysis.

Spondylolysis; Elite athletes; Sports biomechanics; Low back pain; Pars interarticularis

1. Choi, J. H., Ochoa, J. K., Lubinus, A., Timon, S., Lee, Y. P., & Bhatia, N. N. (2022). Management of lumbar spondylolysis in the adolescent athlete: A review of over 200 cases. The Spine Journal, 22(10), 1628–1633. https://doi.org/10.1016/j.spinee.2022.04.011 [Google Scholar] [Crossref]

2. Cassidy, R. C., Shaffer, W. O., & Johnson, D. L. (2005). Spondylolysis and spondylolisthesis in the athlete. Orthopedics, 28(11), 1331–1333. https://doi.org/10.3928/0147-7447-20051101-12 [Google Scholar] [Crossref]

3. Nordby, E. J., Brown, M. D., Dawson, E. D., et al. (Eds.). (1985). A glossary on spinal terminology. American Academy of Orthopaedic Surgeons. [Google Scholar] [Crossref]

4. Narita, T., & Kaneoka, K. (2015). The prevention of low back disorders in divers. In K. Kanosue, T. Ogawa, M. Fukano, & T. Fukubayashi (Eds.), Sports injuries and prevention. Springer. https://doi.org/10.1007/978-4-431-55318-2_33 [Google Scholar] [Crossref]

5. Salminen, J. J., Erkintalo, M. O., Pentti, J., Oksanen, A., & Kormano, M. J. (1999). Recurrent low back pain and early disc degeneration in the young. Spine, 24(13), 1316–1321. https://doi.org/10.1097/00007632-199907010-00008 [Google Scholar] [Crossref]

6. Burton, A. K., Clarke, R. D., McClune, T. D., & Tillotson, K. M. (1996). The natural history of low back pain in adolescents. Spine, 21(20), 2323–2328. https://doi.org/10.1097/00007632-199610150-00004 [Google Scholar] [Crossref]

7. Sundell, C. G., Jonsson, H., Ådin, L., & Larsén, K. H. (2013). Clinical examination, spondylolysis and adolescent athletes. International Journal of Sports Medicine, 34(3), 263–267. https://doi.org/10.1055/s-0032-1321723 [Google Scholar] [Crossref]

8. Tawfik, S., Phan, K., Mobbs, R. J., & Rao, P. J. (2020). The incidence of pars interarticularis defects in athletes. Global Spine Journal, 10(1), 89–101. https://doi.org/10.1177/2192568218823695 [Google Scholar] [Crossref]

9. Gadia, A., Shah, K., & Nene, A. (2018). Outcomes of various treatment modalities for lumbar spinal ailments in elite athletes: A literature review. Asian Spine Journal, 12(4), 754–764. https://doi.org/10.31616/asj.2018.12.4.754 [Google Scholar] [Crossref]

10. Berger, R. G., & Doyle, S. M. (2019). Spondylolysis 2019 update. Current Opinion in Pediatrics, 31(1), 61–68. https://doi.org/10.1097/MOP.0000000000000706 [Google Scholar] [Crossref]

11. Logroscino, G., Mazza, O., Aulisa, G., Pitta, L., Pola, E., & Aulisa, L. (2001). Spondylolysis and spondylolisthesis in the pediatric and adolescent population. Child's Nervous System, 17(11), 644–655. https://doi.org/10.1007/s003810100495 [Google Scholar] [Crossref]

12. Toueg, C. W., Mac-Thiong, J. M., Grimard, G., Parent, S., Poitras, B., & Labelle, H. (2010). Prevalence of spondylolisthesis in a population of gymnasts. Studies in Health Technology and Informatics, 158, 132–137. [Google Scholar] [Crossref]

13. Rossi, F., & Dragoni, S. (2001). The prevalence of spondylolysis and spondylolisthesis in symptomatic elite athletes: Radiographic findings. Radiography, 7(1), 37–42. https://doi.org/10.1053/radi.2000.0299 [Google Scholar] [Crossref]

14. Calvo-Muñoz, I., Gómez-Conesa, A., & Sánchez-Meca, J. (2013). Prevalence of low back pain in children and adolescents: A meta-analysis. BMC Pediatrics, 13, Article 14. https://doi.org/10.1186/1471-2431-13-14 [Google Scholar] [Crossref]

15. Jackson, D. W., Wiltse, L. L., & Cirincoine, R. J. (1976). Spondylolysis in the female gymnast. Clinical Orthopaedics and Related Research, (117), 68–73. [Google Scholar] [Crossref]

16. Ichikawa, N., Ohara, Y., Morishita, T., Taniguichi, Y., Koshikawa, A., & Matsukura, N. (1982). An aetiological study on spondylolysis from a biomechanical aspect. British Journal of Sports Medicine, 16(3), 135–141. https://doi.org/10.1136/bjsm.16.3.135 [Google Scholar] [Crossref]

17. Caldarone, G. (1984). [Morphological-structural alterations of the isthmus in athletes of various sports disciplines]. Gymnica, 1. [Google Scholar] [Crossref]

18. Ottolenghi, G., Alessi, G. C., Oggero, P., & Buccelli, R. (1985). Alterazioni del rachide lombosacrale da micropolitraumatismi sportivi [Changes in the lumbosacral spine caused by sports microtraumas]. Minerva Medica, 76(45-46), 2203–2212. [Google Scholar] [Crossref]

19. McCarroll, J. R., Miller, J. M., & Ritter, M. A. (1986). Lumbar spondylolysis and spondylolisthesis in college football players: A prospective study. The American Journal of Sports Medicine, 14(5), 404–406. https://doi.org/10.1177/036354658601400513 [Google Scholar] [Crossref]

20. Dragoni, S., & Candela, V. (1992). Lombalgia da sport. Ed. Geigy. [Google Scholar] [Crossref]

21. Morita, T., Ikata, T., Katoh, S., & Miyake, R. (1995). Lumbar spondylolysis in children and adolescents. The Journal of Bone and Joint Surgery. British volume, 77(4), 620–625. [Google Scholar] [Crossref]

22. Lim, M. R., Yoon, S. C., & Green, D. W. (2004). Symptomatic spondylolysis: Diagnosis and treatment. Current Opinion in Pediatrics, 16(1), 37–46. https://doi.org/10.1097/00008480-200402000-00008 [Google Scholar] [Crossref]

23. Wiltse, L. L., Widell, E. H., Jr., & Jackson, D. W. (1975). Fatigue fracture: The basic lesion in isthmic spondylolisthesis. The Journal of Bone and Joint Surgery. American volume, 57(1), 17–22. [Google Scholar] [Crossref]

24. Micheli, L. J., & Wood, R. (1995). Back pain in young athletes: Significant differences from adults in causes and patterns. Archives of Pediatrics & Adolescent Medicine, 149(1), 15–18. https://doi.org/10.1001/archpedi.1995.02170130017004 [Google Scholar] [Crossref]

25. Cyron, B. M., & Hutton, W. C. (1978). The fatigue strength of the lumbar neural arch in spondylolysis. The Journal of Bone and Joint Surgery. British volume, 60-B(2), 234–238. https://doi.org/10.1302/0301-620X.60B2.659472 [Google Scholar] [Crossref]

26. Rosenberg, N. J., Bargar, W. L., & Friedman, B. (1981). The incidence of spondylolysis and spondylolisthesis in nonambulatory patients. Spine, 6(1), 35–38. https://doi.org/10.1097/00007632-198101000-00005 [Google Scholar] [Crossref]

27. Weiker, G. G. (1989). Evaluation and treatment of common spine and trunk problems. Clinics in Sports Medicine, 8(3), 399–417. [Google Scholar] [Crossref]

28. Schulitz, K. P., & Niethard, F. U. (1980). Strain on the interarticular stress distribution: Measurements regarding the development of spondylolysis. Archives of Orthopaedic and Traumatic Surgery, 96(3), 197–202. https://doi.org/10.1007/BF00457783 [Google Scholar] [Crossref]

29. Jacob, H. A. C., & Suezawa, Y. (1985). On the initiation of spondylolysis through mechanical factors. In S. M. Perren & E. Schneider (Eds.), Biomechanics: Current interdisciplinary research (Vol. 2). Springer. https://doi.org/10.1007/978-94-011-7432-9_76 [Google Scholar] [Crossref]

30. Farfan, H. F., Osteria, V., & Lamy, C. (1976). The mechanical etiology of spondylolysis and spondylolisthesis. Clinical Orthopaedics and Related Research, (117), 40–55. [Google Scholar] [Crossref]

31. Junghanns, H., & Hager, H. (1990). Clinical implications of normal biomechanical stresses on spinal function. Aspen Publishers. [Google Scholar] [Crossref]

32. Troup, J. D. (1976). Mechanical factors in spondylolisthesis and spondylolysis. Clinical Orthopaedics and Related Research, (117), 59–67. [Google Scholar] [Crossref]

33. Hutchinson, M. R. (1999). Low back pain in elite rhythmic gymnasts. Medicine & Science in Sports & Exercise, 31(11), 1686–1688. https://doi.org/10.1097/00005768-199911000-00027 [Google Scholar] [Crossref]

34. Roussouly, P., Gollogly, S., Berthonnaud, E., Labelle, H., & Weidenbaum, M. (2006). Sagittal alignment of the spine and pelvis in the presence of L5-s1 isthmic lysis and low-grade spondylolisthesis. Spine, 31(21), 2484–2490. https://doi.org/10.1097/01.brs.0000239155.37261.69 [Google Scholar] [Crossref]

35. Soler, T., & Calderón, C. (2000). The prevalence of spondylolysis in the Spanish elite athlete. The American Journal of Sports Medicine, 28(1), 57–62. https://doi.org/10.1177/03635465000280012101 [Google Scholar] [Crossref]

36. Bono, C. M. (2004). Low-back pain in athletes. The Journal of Bone and Joint Surgery. American volume, 86(2), 382–396. https://doi.org/10.2106/00004623-200402000-00027 [Google Scholar] [Crossref]

37. Hensinger, R. N. (1983). Spondylolysis and spondylolisthesis in children. Instructional Course Lectures, 32, 132–151. [Google Scholar] [Crossref]

38. Rossi, F. (1978). Spondylolysis, spondylolisthesis and sports. The Journal of Sports Medicine and Physical Fitness, 18(4), 317–340. [Google Scholar] [Crossref]

39. Ladenhauf, H. N., Fabricant, P. D., Grossman, E., Widmann, R. F., & Green, D. W. (2013). Athletic participation in children with symptomatic spondylolysis in the New York area. Medicine & Science in Sports & Exercise, 45(10), 1971–1974. https://doi.org/10.1249/MSS.0b013e318294b4ed [Google Scholar] [Crossref]

40. Beutler, W. J., Fredrickson, B. E., Murtland, A., Sweeney, C. A., Grant, W. D., & Baker, D. (2003). The natural history of spondylolysis and spondylolisthesis: 45-year follow-up evaluation. Spine, 28(10), 1027–1035. https://doi.org/10.1097/01.BRS.0000061992.98108.A0 [Google Scholar] [Crossref]

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