A 15-year-old boy has low back pain exacerbated by hyperextension. Standing lateral X-ray shows a defect in the pars interarticularis of L5 (Scotty dog with a collar). There is a grade II spondylolisthesis. The first-line management is:
- A Immediate posterior spinal fusion L5-S1
- B Pars repair with Buck's screw fixation
- C Activity modification, physical therapy (core strengthening, hamstring stretching), and bracing for 3-6 months ✓
- D Reduction of slip and anterior lumbar interbody fusion
Explanation
Isthmic spondylolysis/spondylolisthesis in adolescents is initially managed conservatively: activity restriction (avoiding hyperextension sports), lumbar extension bracing, and physiotherapy focusing on core stabilization, hip flexor and hamstring stretching. This results in symptom resolution in 80-90% of cases within 3-6 months. Surgical treatment (posterior fusion L5-S1 ± reduction) is reserved for grade III/IV slips, neurological deficits, or failure of conservative management after 6 months. Grade II slips (<50% slip) in adolescents rarely require immediate surgery. Buck's screw is for isolated pars repair in young athletes with spondylolysis without slip.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.