Low back pain is not a frequent complaint in adolescents and usually is a self-limited affliction without signs or significant findings in pertinent imaging studies. Adolescent athletes are in an increased risk of overuse injuries to the spine due to their relative ligamentous laxity and lack of proper technique in their chosen sport. This is a prospective study of adolescent athletes referred to the spine clinic due to low back pain and significant findings on physical examination and/or the imaging studies. Between 01.08.1998 and 31.03.2001 we have treated 7 athletes, 2 girls and 5 boys, average age 15.67 years (range 13–17). Sports involved were golf in 2, body building in 1, volleyball in 1, handball in 1, track and field in 1, and ballet in 1. Five were eventually diagnosed with L5 pars defects (2 unilateral and 3 with bilateral lesions); L2 spondylolysis was diagnosed in 1 and L5-S1 central disc protrusion in 1. All complained of pain located to the lower back, the patient with disc protrusion complained of pain radiating to her lower extremities. Plain films were diagnostic in 1 patient only with a unilateral L5 pars defect. Technetium bone scan showed increased uptake at the level of the lesion in all 6 patients with spondylolysis and was normal in the patient with L5-S1 disc protrusion. CT scans were performed in 4 patients and were diagnostic 2, MRI was performed in 2 patients and was diagnostic in both. The six patients with spondylolysis were treated by analgesics, rest for 3 months and then gradual supervised return to sports with modification of the swing in both golfers, decrease of training volume in the body builder and limiting the track and field athlete to running only. Both volleyball and handball players withdrew from athletic activities. The volleyball player with L5-S1 herniation refused surgical treatment. The evaluation of adolescent athletes with low back pain longer than few weeks, should be by bone scan first and CT and/or MRI later. MRI should be preferred to limit radiation exposure. After proper rest and supervised training they can safely resume their athletic interests.
