Sex-specific Differences In Healing Rates Of Spondylolysis In Adolescent Athletes

Spondylolysis is a common diagnosis in adolescent athletes presenting with lumbar pain following low back hyperextension. Physical therapy typically leads to symptom resolution. However, follow-up imaging to confirm radiographic healing is not part of care guidelines. Therefore, there is no literature investigating radiographic healing in these patients. PURPOSE: To investigate sex-specific radiographic healing rates in adolescent spondylolysis following non-operative treatment. METHODS: A retrospective review was conducted of spondylolysis cases treated by a single physician between September 2022 and May 2024. Patients included were < 19 years old, had spondylosis confirmed by single photon emission computed tomography (SPECT) scan, and a 3-month follow-up SPECT scan. Patients who underwent surgical treatment or had chronic spondylosis were excluded. Demographic data along with injury-specific details such as date of injury, Hollenberg grade, laterality, and spinal level were collected. RESULTS: 100 patients, 79 male and 21 female athletes, were included in the final analysis. Sex-based differences in spondylolysis patterns and healing were reported in Table 1. The average age at the time of injury was 15.0 years old (range: 9 - 18). After 3 months of non-operative treatment, 73 male athletes demonstrated healing (92.4%) and 20 female athletes demonstrated healing (95.2%; p-value: 0.652). There was a significantly greater distribution of grade I fractures observed in female patients (23.8%) compared to male patients (6.3%; p-value: 0.070). CONCLUSIONS: These results suggest there are no sex-specific differences in spondylolysis healing rates.