Spondylolysis, or a bony deficiency in the pars intra-articularis, is a common cause of low back pain among children and adolescents. Symptoms typically include low back pain with occasional hamstring tightness. The classic radiographic finding is the presence of the 'Scotty dog sign, which is visualized best on the oblique lumbar radiograph. In this view, the outline of the posterior elements of the spine resemble a Scottish terrier, with the defect of the pars intra-articularis seen as a lucency crossing the neck of the Scotty dog. Most authors believe that spondylolysis is an overuse syndrome, particularly in patients that participate in hyperextension activities, especially gymnastics, interior football linemen, and swimmers who perform the butterfly stroke. Initial management is conservative treatment with activity modification and therapeutic modalities as needed. Surgical intervention, injections, and computed tomography myelogram are not indicated in the patient that presents for the first time with isolated back pain symptoms.
- Activity modification with therapeutic modalities.
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