Asymptomatic L5 Spondylolysis Does Not Necessarily Preclude Elite Gymnastics Participation: A Case Report.

CASE: An 8-year-old girl world-level rhythmic gymnast was diagnosed with bilateral L5 pars interarticularis defects and was asymptomatic. Imaging showed bilateral spondylolysis without spondylolisthesis or degeneration. Despite recommendations for sport restriction and external scrutiny, she continued elite training under specialist surveillance. Serial imaging over 18 years demonstrated persistent defects without progression. She competed internationally for >10 years without pain or limitation.

CONCLUSION: Bilateral pediatric spondylolysis may remain clinically and radiographically stable despite extreme loading. This case highlights the importance of symptom-guided management and the psychosocial consequences of restrictive recommendations when radiographic findings do not correlate with clinical outcomes.