Relationship between time from onset of lower back pain to medical examination and recurrence and stage of disease in lumbar spondylolysis

Abstract

Background

Lumbar spondylolysis, a stress fracture, is frequently observed in adolescent athletes performing repetitive spinal extension and rotation. Early diagnosis and treatment are crucial to prevent progression and recurrence. However, the impact of the time from symptom onset to consultation on disease stage and recurrence remains unclear.

Objective

This study investigated whether delayed consultation influences the disease stage at diagnosis and recurrence in adolescent athletes with lumbar spondylolysis.

Methods

A retrospective cohort study was conducted at Hospital A from April 2022 to April 2025. Data included age, sex, sport type, lesion location, disease stage (early, advanced, or terminal), consultation timing (<30 or >30 days), and recurrence. Fisher's exact test was used for univariate analysis, and variables with P < 0.20 were entered into a logistic regression model to identify independent predictors.

Results

Eighty-three athletes (53 males, 30 females; mean age 14.9 ± 1.9 years) were analyzed. Univariate analysis revealed that delayed consultation and advanced disease stage were significantly associated with recurrence. Logistic regression identified disease stage as the only independent predictor (OR = 0.06, 95% CI: 0.01–0.32, P < 0.0011).

Conclusion

A delay in consultation was not an independent predictor of recurrence; however, it indirectly increased the risk of recurrence by contributing to disease stage advancement at the time of diagnosis. These findings highlight that timely consultation can prevent disease progression and lower recurrence risk. Educating athletes, parents, and coaches about early medical evaluation is essential to improve clinical outcomes and ensure a safe return to sports.