Pediatric and Adolescent Spondylolysis/ Spondylolisthesis

Spondylolysis and spondylolisthesis are the most common causes of low back pain in adolescent athletes.

Spondylolysis is a stress fracture in a portion of a vertebrae (spine) bone called the pars interarticularis. It usually affects the 5th lumbar vertebrae at L5-S1 and less commonly the 4th lumbar vertebrae at L4-5.

Spondylolisthesis occurs when bilateral pars defects cause the vertebrae to shift out of place. The stress fracture may weaken the bone, making it
unable to maintain its proper position. The bone then slips forward over another bone. If too much slippage happens, the bone(s) may start to put pressure on nerves.

Causes of Spondylolysis and Spondylolisthesis:

  • Spondylolysis and spondylolisthesis are caused by repetitive impact, overuse, and/or hyper-extension of the low back.
  • Most often seen in adolescent athletes between 10 and 17 years of age.
  • Sports that require the athlete to frequently or constantly over-extend the back – such as gymnastics, volleyball, or football – may also lead to injury
  • Genetics may play a role. There may also be a link to periods of rapid growth (growth spurts).

Signs and symptoms of an Pediatric and Adolescent Spondylolysis/ Spondylolisthesis may include:
  • Low back pain related to activity
  • Pain is aggravated by activity and improves with rest
  • Tenderness to palpation along the vertebral spinous processes (bony prominences along the back)
  • Tightness in the hamstring muscles

Taking a break from symptom provoking activity until the pain goes away reduces stress to the bone as it heals. This often takes 3 months or more. Gradually
resume activity as pain allows.

Rehabilitation exercises

Increasing core strength and improving hamstring flexibility will help minimize symptoms. Your provider may refer you to a physical therapist for specific rehabilitation exercises.

Lumbar brace

Immobilizes and supports the spine for a short period of time while the injury heals.


If slippage progressively worsens, pain is not responding to non-surgical treatment or is interfering with activities of daily living, surgery may be recommended.