This 2006 narrative review by Cavalier et al. synthesizes the diagnosis, natural history, and nonsurgical management of spondylolysis and spondylolisthesis in children and adolescents, covering stress reactions through high-grade slips across both isthmic and dysplastic subtypes.
When a skeletally immature patient presents with activity-related low back pain and hamstring tightness, obtain standing lateral and oblique lumbosacral radiographs and add SPECT if plain films are normal — then stratify by slip grade and type: low-grade isthmic slips get activity restriction and specific stabilization exercises, while any symptomatic high-grade slip or progressive dysplastic lesion warrants surgical referral.
Dysplastic spondylolisthesis demands closer follow-up than isthmic — its 32% progression rate versus 4% means an asymptomatic child still needs serial exams and radiographs every 6–9 months through skeletal maturity.
This 2006 narrative review by Cavalier et al. synthesizes the diagnosis, natural history, and nonsurgical management of spondylolysis and spondylolisthesis in children and adolescents, covering stress reactions through high-grade slips across both isthmic and dysplastic subtypes.
When a skeletally immature patient presents with activity-related low back pain and hamstring tightness, obtain standing lateral and oblique lumbosacral radiographs and add SPECT if plain films are normal — then stratify by slip grade and type: low-grade isthmic slips get activity restriction and specific stabilization exercises, while any symptomatic high-grade slip or progressive dysplastic lesion warrants surgical referral.
Dysplastic spondylolisthesis demands closer follow-up than isthmic — its 32% progression rate versus 4% means an asymptomatic child still needs serial exams and radiographs every 6–9 months through skeletal maturity.