Asymptomatic L5 Spondylolysis Does Not Necessarily Preclude Elite Gymnastics Participation: A Case Report

Area of Science:

• Sports Medicine
• Pediatric Orthopedics
• Radiology

Background:

• Bilateral L5 pars interarticularis defects (spondylolysis) are common in young athletes.
• Elite rhythmic gymnastics involves extreme spinal loading.
• Previous recommendations often advise sport restriction for spondylolysis.

Purpose of the Study:

• To evaluate the long-term clinical and radiographic course of pediatric spondylolysis in an elite athlete.
• To assess the impact of continued high-level training on spondylolysis.
• To explore the utility of symptom-guided management versus restrictive recommendations.

Main Methods:

• Case report of an 8-year-old rhythmic gymnast diagnosed with asymptomatic bilateral L5 spondylolysis.
• Serial imaging (X-rays, MRI) over 18 years.
• Clinical surveillance focusing on pain and functional limitations during elite international competition.

Main Results:

• Persistent bilateral L5 pars defects without progression, spondylolisthesis, or degeneration over 18 years.
• The athlete remained asymptomatic and competed internationally for over 10 years.
• No adverse clinical outcomes despite continued extreme spinal loading.

Conclusions:

• Bilateral pediatric spondylolysis can remain stable under extreme loading conditions.
• Symptom-guided management is effective, even with radiographic abnormalities.
• Restrictive recommendations may have significant psychosocial consequences without clear clinical benefit.