Natural Progression Patterns of Lumbar Spondylolysis and Low-grade Spondylolisthesis in Late Adolescents
Spine · 20 Jul 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
It challenges the long-held belief that spondylolysis/low-grade spondylolisthesis is inert after skeletal maturity, suggesting that most of these patients still need long-term monitoring for pain and disc degeneration even though frank slippage rarely worsens.
The evidence
This multicentre cohort followed 154 adolescents who had bilateral pars defects or low-grade spondylolisthesis for a median of 10.5 years after they reached skeletal maturity, tracking slip progression, disc degeneration, back pain, and neurologic symptoms with no intervention performed. Actual vertebral slippage progressed in only 7.1% of patients, but 30.5% developed worsening disc degeneration on MRI, 44.2% had clinically significant worsening of low back pain, and 4.5% developed new neurologic symptoms, giving an overall combined progression rate of 56.5%; L5-level lesions, sarcopenia, and sedentary behaviour were independently associated with this combined progression.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Prospective cohort
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerNot reported
- Prospective registrationNot reported
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.The study dichotomized continuous variables like BMI and sitting time at the median for convenience, and treated any surgery during follow-up as automatically positive for all four progression endpoints; how might these methodological choices have inflated the reported 56.5% multidimensional progression rate?
2.Given that slip progression itself was rare (7.1%) and no risk factors predicted isolated IVDD or LBP progression, how should this natural history data change how you counsel a skeletally mature adolescent found incidentally to have low-grade spondylolisthesis?
Original publication title
Natural Progression Patterns of Lumbar Spondylolysis and Low-grade Spondylolisthesis in Late Adolescents