Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association · 2026
Conservative treatment with continued sports participation for early-stage lumbar spondylolysis: An exploratory study of bone union outcomes in adolescent athletes.
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Fujimoto Shutaro, Obara Hisashi, Ohshima Takafumi, Fukushi Ryunosuke, Tsukamoto Arihiko, Hirota Ryosuke, Morita Tomonori, Kozakai Yutaka, Teramoto Atsushi
Аннотация
BACKGROUND: Conservative treatment for lumbar spondylolysis traditionally requires cessation of sports activities until bone union is achieved. However, prolonged interruption of sports participation can be difficult for adolescent athletes. This study investigated the bone union outcomes of conservative treatment allowing continued sports participation in patients with lumbar spondylolysis.
METHODS: Pediatric athletes (≤18 years) diagnosed with very early- or early-stage lumbar spondylolysis between April 2023 and October 2024 were retrospectively reviewed. Patients selected either conservative treatment with continued sports participation (CSP) or conservative treatment with sports cessation (SC) through shared decision-making. In the CSP group, sports activities while wearing a brace designed to limit lumbar extension were resumed after a 2-week period of rest. In the SC group, sports activities were discontinued until bone union was confirmed. In both groups, physical therapy focusing on trunk stability and mobility of adjacent joints was started at the time of diagnosis. The bone union rate and time to bone union were assessed in both groups.
RESULTS: Twelve patients (16 lesions) were included. Six patients (8 lesions) selected CSP, and six patients (8 lesions) selected SC. In the CSP group, bone union was achieved in 7 of 8 lesions, with no progression observed in the remaining lesion. In the SC group, bone union was achieved in all lesions. The mean time to bone union was 4.1 ± 1.7 months in the CSP group and 3.6 ± 1.8 months in the SC group. All patients in the CSP group were able to continue sports without restriction.
CONCLUSIONS: In this exploratory study, conservative treatment with continued sports participation resulted in a high rate of bone union, particularly in unilateral, very early- and early-stage lumbar spondylolysis. Given the small sample size and non-randomized design, these findings do not demonstrate equivalence to sports cessation, but suggest that continued sports participation may be feasible in carefully selected patients.
METHODS: Pediatric athletes (≤18 years) diagnosed with very early- or early-stage lumbar spondylolysis between April 2023 and October 2024 were retrospectively reviewed. Patients selected either conservative treatment with continued sports participation (CSP) or conservative treatment with sports cessation (SC) through shared decision-making. In the CSP group, sports activities while wearing a brace designed to limit lumbar extension were resumed after a 2-week period of rest. In the SC group, sports activities were discontinued until bone union was confirmed. In both groups, physical therapy focusing on trunk stability and mobility of adjacent joints was started at the time of diagnosis. The bone union rate and time to bone union were assessed in both groups.
RESULTS: Twelve patients (16 lesions) were included. Six patients (8 lesions) selected CSP, and six patients (8 lesions) selected SC. In the CSP group, bone union was achieved in 7 of 8 lesions, with no progression observed in the remaining lesion. In the SC group, bone union was achieved in all lesions. The mean time to bone union was 4.1 ± 1.7 months in the CSP group and 3.6 ± 1.8 months in the SC group. All patients in the CSP group were able to continue sports without restriction.
CONCLUSIONS: In this exploratory study, conservative treatment with continued sports participation resulted in a high rate of bone union, particularly in unilateral, very early- and early-stage lumbar spondylolysis. Given the small sample size and non-randomized design, these findings do not demonstrate equivalence to sports cessation, but suggest that continued sports participation may be feasible in carefully selected patients.