What follows are highlights from these studies:

Surgery Unnecessary for Most Adolescent Athletes with Lumbar Spine Stress Fracture

A new study by researchers at HSS shows that 95 percent of adolescent athletes who are diagnosed with acute spondylolysis heal with just rest, bracing, and physical therapy. These findings support treating patients with a conservative, non-operative approach and reserving surgery as a last-resort option.

“These results are important because when we sit with families to discuss treatment options, we can confidently tell them that the vast majority of patients do have resolution of their pain and are able to return to sports without having to undergo surgery,” explains Jessica H. Heyer, MD, a pediatric orthopedic and spine surgeon at HSS and senior author of the study.

Spondylolysis is a stress injury or fracture of the pars (a bone structure in the vertebrae located at the bottom of the lumbar spine) that often causes lower back pain. It is prevalent among teenage and pre-teen athletes, especially those who repeatedly bend backwards (hyperextend or twist the lower back) such as soccer players, rowers, baseball players, gymnasts, and football players.

The retrospective review included 179 children and teenagers diagnosed with spondylolysis between February 2016 and August 2024. According to the findings, 95% of the patients were free of pain and able to return to their activities after three months of rest, bracing, and physical therapy. Only 5% of this group went on to require surgery, which can involve either a direct repair of the pars with a screw, or a fusion around the pars injury.   

“We saw an excellent rate of return to sports and resolution of pain among the patients in our study,” notes Dr. Heyer, adding that the protocols for non-operative management of spondylolysis vary across the country.

“These results support our recommendation to restrict activity for a full three months and initiate physical therapy after 4 to 6 weeks of rest,” she says. “This period of restricted activity is important to allow for clinical improvement of pain and healing before deciding on whether surgery is needed.”

Growth Hormone Therapy May Increase Risk of Fractures in Children and Teens

A new study by researchers at HSS shows a strong association between growth hormone (GH) therapy and an increased risk of physeal fractures, a pediatric bone injury affecting the growth plate near the ends of long bones such as the wrist, fingers, and lower legs. These fractures are responsible for 15% to 30% of all childhood fractures and are common among adolescents who are active in sports. 

“We found that GH therapy was associated with an increased rate of physeal fractures in the upper and lower extremities,” says Emily Dodwell, MD, MPH, a pediatric orthopedic surgeon at HSS and senior author of the study. “These findings are important because they provide more data to consider as we help families weigh the risks and benefits of GH therapy.”

Previous research has yielded contradictory findings about whether exposure to GH therapy increases the risk of physeal fractures.

“With prior studies being inconclusive, we wanted to investigate the potential association between GH and pediatric physeal fractures on a national basis,” explains Dr. Dodwell.

GH therapy is used to treat children who are diagnosed with GH deficiency[EN1] , certain genetic syndromes, short stature, and small for gestational age. GH therapy can help increase a child’s height, growth rate, and bone mineral density, and improve their body composition and key bloodwork parameters used to test for metabolic syndrome, diabetes risk, and overall cardiovascular health. However, it has also been linked to orthopedic complications, such as progression of scoliosis (curvature of the spine) and increased risk of slipped capital femoral epiphysis (a painful hip condition).

Dr. Dodwell and her colleagues used a nationwide insurance claims database to identify prevalence of pediatric physeal fractures in the upper and lower extremities with and without GH exposure. Their database search included 34,196 patients aged 4 to 18 years old who were given GH therapy for at least one month between 2010 and 2022 and were followed for two or more years. The researchers compared this group to the same number of patients who did not receive GH therapy during that time, taking into account age, sex, and weight.

The analysis found that GH therapy was associated with a higher rate of physeal fractures. These included fractures at the proximal humerus (arm near the shoulder), proximal radius (forearm near the elbow), distal radius (forearm near the wrist), distal ulna (wrist joint), distal femur (thigh bone above the knee joint), proximal tibia (upper shin bone below the knee), and distal tibia (lower shin bone near the ankle).

“This retrospective study was not designed to determine whether GH actually causes these fractures,” notes Dr. Dodwell. “Physicians should bear that in mind when counseling patients regarding the risks and benefits of GH therapy.”

Further research is needed to confirm these findings, she adds.

By the time she saw a doctor after the lockdown lifted, she could barely walk for 10 minutes without having to stop. Sometimes, the pain shot down her leg. “I couldn’t do much physical activity,” she recalls. “Simple tasks like standing and doing dishes became painful. At times it felt like someone was pulling both ends of the nerve in my left leg really tight.”

After seeing several doctors, Amanda, who lives in Bay Shore, Long Island, was referred to Darren R. Lebl, MD, MBA, a spine surgeon at Hospital for Special Surgery (HSS) who practices in both Manhattan and at HSS Long Island in Uniondale. Around the time she saw Dr. Lebl, he had just completed his 100^th minimally invasive, robotic-assisted spine surgery.

The robotic system would be used in Amanda’s surgery to correct a spinal condition called spondylolisthesis, which causes one of the lower vertebrae of the spine to slip forward onto the bone directly beneath it. This was putting pressure on a nerve.

The first step for Amanda was a virtual visit with Dr. Lebl. After she felt comfortable talking to him remotely, she went to his office for an examination and for an explanation of her condition and what surgery would entail. He explained that he performed the procedure with assistance from robotic technology in the O.R., which allowed for an ultraprecise surgery.

“Over the past few years, advances in surgical technique and technology have enhanced the accuracy and predictability of spinal surgeries, and patients like Amanda benefit,” said Dr. Lebl. “Advances such as computer navigation, 3D imaging and robotic-assisted surgery have been tremendous in terms of allowing us to do less invasive, yet more precise surgeries.”

The use of very small incisions preserves muscles and other structures surrounding the spine, so patients generally experience less pain after surgery, a shorter hospital stay and a quicker return to activities compared to traditional open surgery, he explains.

Amanda had a spinal fusion in December 2020. “A vertabra in her lower spine had shifted or ‘slipped’ forward, causing impingement on a nerve root,” Dr. Lebl explained. “Through a minimally invasive technique, we were able to realign her spine and take the pressure off the nerve to relieve her pain.”

Dr. Lebl uses the robotic system to treat conditions such as Amanda’s, as well as a herniated disc, spinal stenosis or scoliosis. Prior to surgery, detailed images of the patient’s anatomy are obtained to plan and customize the procedure for each individual patient. Preoperative CT and MRI scans create a three-dimensional map of the patient’s spine that is used during surgery. Dr. Lebl performs the procedure with small incisions and robotic guidance, always maintaining full control. Visualization of the surgical field is provided by a computer console that displays the high-definition 3D image of the patient’s anatomy in real time.

Many spine surgeries, including Amanda’s, require the use of hardware such as titanium screws to stabilize the spine, and their accurate placement is critical to the success of the surgery. “The robotic arm, along with 3D imaging and navigation technology similar to GPS, allow for pinpoint accuracy in the placement of hardware, and this is a major advantage of the system,” Dr. Lebl says.

Amanda said the thought of having spine surgery was a frightening prospect, especially during the pandemic. It would be the first surgery she ever had, and she was worried about pain. But it was never an issue. “I was very surprised at how little pain I had after surgery,” she says. “The whole time in the hospital, I never had real pain, it was more like discomfort. The nurses would come in and ask, ‘What is your pain level on a scale of 1 to 10?,’ and for me it was ‘1 to 3.’ Everyone around me was very impressed with how quickly I recovered and how well I’m doing.”

Amanda had her surgery on a Friday and went home on Monday. Now, about six weeks after the procedure, pain-free, she goes to physical therapy and is back to her online classes as a full-time grad student. She is enrolled in a four-year program to receive a Doctor of Audiology degree and looks forward to the day in-person classes and her volunteer work in an audiology clinic can resume.

Dr. Lebl notes that the use of robotics in minimally invasive spine surgery requires special training and advises patients to choose a physician with ample experience in the technique. He also recommends that patients choose a surgeon with whom they feel comfortable and who takes the time to answer all their questions. When considering where to have surgery, hospitals that perform a high-volume of such procedures have been shown to have the best outcomes.