The most common cause of back pain in the adolescent athlete is spondylolysis. Spondylolysis is particularly prevalent in athletes who are involved in sports with repetitive hyperextension. Young patients who demonstrate pain on hyperextension and rotation of the lumbar spine, in particular one-legged hyperextension, are highly suspect for an injury to the pars interarticularis. The diagnostic workup should consist of plain radiographs, including standing anteroposterior, standing lateral, and collimated lateral views of the lumbosacral spine. Early diagnosis, before frank lysis of the pars occurs, can be confirmed by SPECT bone scan. Computer-assisted tomography (CT) scan is used to determine whether the lesion is unilateral or bilateral and, after treatment, to determine whether healing has occurred. Treatment consists of rest from the provoking mechanism and physical rehabilitation including specific core stabilizing exercises. In addition, use of a rigid anti-lordosis brace often facilitates resolution of symptoms, when rest and physical therapy have been ineffective and may allow earlier return to sports. In particular, the Boston Brace has been used specifically in young athletes to reduce lumbar lordosis and affect unwanted forces to the posterior spinal elements. In cases failing conservative therapy, surgical treatment usually consists of in situ posterior fusion.
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