Low back pain is not a frequent complaint in adolescents and usually is a self-limited affliction without signs or significant findings in pertinent imaging studies. Adolescent athletes are in an increased risk of overuse injuries to the spine due to their relative ligamentous laxity and lack of proper technique in their chosen sport.

This is a prospective study of adolescent athletes referred to the spine clinic due to low back pain and significant findings on physical examination and/or the imaging studies.

Between 01.08.1998 and 31.03.2001 we have treated 7 athletes, 2 girls and 5 boys, average age 15.67 years (range 13–17). Sports involved were golf in 2, body building in 1, volleyball in 1, handball in 1, track and field in 1, and ballet in 1. Five were eventually diagnosed with L5 pars defects (2 unilateral and 3 with bilateral lesions); L2 spondylolysis was diagnosed in 1 and L5-S1 central disc protrusion in 1. All complained of pain located to the lower back, the patient with disc protrusion complained of pain radiating to her lower extremities. Plain films were diagnostic in 1 patient only with a unilateral L5 pars defect. Technetium bone scan showed increased uptake at the level of the lesion in all 6 patients with spondylolysis and was normal in the patient with L5-S1 disc protrusion. CT scans were performed in 4 patients and were diagnostic 2, MRI was performed in 2 patients and was diagnostic in both.

The six patients with spondylolysis were treated by analgesics, rest for 3 months and then gradual supervised return to sports with modification of the swing in both golfers, decrease of training volume in the body builder and limiting the track and field athlete to running only. Both volleyball and handball players withdrew from athletic activities. The volleyball player with L5-S1 herniation refused surgical treatment.

The evaluation of adolescent athletes with low back pain longer than few weeks, should be by bone scan first and CT and/or MRI later. MRI should be preferred to limit radiation exposure. After proper rest and supervised training they can safely resume their athletic interests.

Correction of spinal deformities such as those seen in idiopathic scoliosis, are one of the challenging aspects of the spine surgeon’s routine. A significant progress has been made in sense of the surgical approaches, implants design and methods of correction during the last two decades. Since the pioneer conception of Paul Harrington that a scoliotic curve can be corrected by distraction, other methods such as derotation and translation came out as an alternative ways to get a straight and balanced spine. Recently, a new concept of correction for spinal deformities named in-situ contouring, has brought to our attention. This method is based on a 6mm Titanium rod (SCS Eurosurgical Inc.) connected to the spine with a multiple hooks and screws system. The rod is bend according to the curve in the coronal plane and loosely secure with setscrews. Following primary application of the rod, the surgeon begins to bend it manually in situ, in a contrary direction to the curve’s shape. By applying a combination of a sagittal and coronal plane forces, the surgeon is able to achieve a final result of a straight and nicely balanced spine.

Methods: The medical records of patients with idiopathic scoliosis, who had surgery during the last three years, were reviewed. Patients, whose operation evolves using of the SCS system, enrolled into the study group. Clinical as well as radiographical data were retrieved from the hospital charts. Curves were classified according to King et al., measurements were taken using the Cobb’s method.

Results: There were 10 patients in the study group (7 females, 3 males, mean age: 16.6 years). All curves were primary thoracic from which 9 were type II and only one was type III. Mean pre-operative angle of the primary curve was 56°, mean post-operative angle was 22° with a 61% correction rate. Patients were followed for an average period of 12 months. No complications related to surgery, correction techniques, or neurological status was noted.

Conclusions: The in-situ contouring system has no drawbacks compare to other known methods. Our feeling is that this new technique gives the surgeon an ability to achieve the final position of the corrected spine, by a slow and gradual manipulation. This is taking a crucial advantage of the elastic property of the spine in order to get good correction and to avoid neurological complications or hooks pull out.