Comparative outcomes of motion-preserving techniques for lumbar spondylolysis in young athletes

Symptomatic lumbar spondylolysis often disables young athletes. We compared three motion-preserving techniques-modified Scott (MST), pedicle screw system (PSS), and dual-stability construct (DSC)-for pars healing and functional recovery.

We retrospectively reviewed 103 active adults (18-40 years) with L3/L4/L5 spondylolysis treated at a single centre between 2017 and 2023. Patients were allocated to modified Scott (MST, n = 33), pedicle-screw (PSS, n = 27) or dual-stability construct (DSC, n = 43). All underwent isthmic debridement, autologous grafting and identical rehabilitation. CT (computed tomography) evaluated pars healing; VAS (Visual Analogue Scale) and JOA-L (Japanese Orthopaedic Association) scores, complications and Magnetic resonance imaging (MRI) Pfirrmann grading were recorded.

At 17.5 ± 6.5 months, DSC achieved the highest healing rate (95.3%) versus PSS (88.9%) and MST (60.6%) (P < 0.001). DSC and PSS were independent predictors of healing (Risk ratios (RR) 12.9 and 4.6 vs. MST). JOA improvement was greatest with DSC (80.53%) and PSS (79.89%) versus MST (67.74%). MST exhibited 12% implant failure (spinous cut-through). No adjacent-disc degeneration was observed in PSS or DSC, supporting short-term motion preservation. CT type II/III defects and overweight status predicted non-union.

PSS and DSC offer significant advantages over MST for treating symptomatic lumbar spondylolysis in young active adults, with DSC yielding the most favorable outcomes. The dual-stability construct, integrating intra- and intersegmental fixation, enhances pars healing and maintains disc health, supporting its use as a motion-preserving and biomechanically robust technique. These findings may guide surgical decision-making and contribute to improved recovery and functional restoration in athletic youth.