Natural Progression Patterns of Lumbar Spondylolysis and Low-grade Spondylolisthesis in Late Adolescents: A Multicentral, Non-interventional, Longitudinal Cohort Study.

Abstract

A retrospective follow-up analysis of prospectively enrolled multicenter cohort with a minimum follow-up of 7 years. To characterize the natural multidimensional progression patterns of lumbar spondylolysis and low-grade spondylolisthesis in skeleton-mature adolescents from the perspective of radiological changes and alterations in clinical symptoms. Clinical practitioners' understanding of the natural progression patterns of lumbar spondylolysis and low-grade spondylolisthesis in late adolescents remain insufficiently recognized. Traditionally, this spinal deformity was considered mechanically stable after skeletal maturity, while few studies focused on multidimensional degenerative and symptomatic changes. From Jan 2013 to Dec 2018, late adolescents with lumbar bilateral spondylolysis or low-grade spondylolisthesis were prospectively enrolled from four high-volume spine centers. Non-interventional observation was assigned to track spondylolysis-related multidimensional progressive endpoints, including slippage, intervertebral disc degeneration (IVDD), lower back pain (LBP), and neurogenic symptoms. Plain photography and MRI scanning were utilized to assess radiological endpoints. Patient-reported records and physical examinations were retrospectively extracted for symptomatic endpoints assessment. In post-hoc analysis, binomial logistic regression model was used to identify risk factors for multidimensional progression. Among 165 participants, 154 were qualified with complete records with a median follow-up period of 10.5 years (range: 7-14 y). During the entire follow-up, 11 cases (7.1%) showed slip progression, while 47 cases (30.5%) had MRI-evidenced progression of IVDD. For symptomatic endpoints, LBP progression was recorded for 68 cases (44.2%), while progression of neurogenic symptom was confirmed for 7 cases (4.5%). The overall multidimensional progression rate reached 56.5%. In post-hoc analysis, binary logistic regression analysis identified L5 index, sarcopenia, and sedentary behavior as risk factors for overall multidimensional progression independent of covariates. This study clarifies the long-term multidimensional progression patterns of late adolescents with lumbar spondylolysis and low-grade spondylolisthesis. After skeletal maturity, this disorder demonstrates mechanical stability with low slip progression rate, while early IVDD and progressive LBP constitute the dominant progressive manifestations. Clinicians should conduct regular monitoring for this special population, especially for patients with L5-level lesion, sarcopenia, and sedentary behavior, to enable early identification of multidimensional progression and optimize long-term individual management strategies.