Spondylolysis
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Spondylolysis

Pronounced: spon-dee-low-lie-sis

En Español (Spanish Version)

Definition

Spondylolysis is a stress fracture involving the pars interarticularis of one of the vertebral bones of the spine. The pars interarticularis is located on left and right, between the upper and lower azygapophysial or facet joints, and connects the vertebral body in front with the vertebral arch behind (posterior).

This condition occurs in the lower back (at L5 90% of the time) and can be on one or both sides (bilateral). Left untreated, bilateral spondylolysis can lead to spondylolisthesis. This is a more serious condition in which one vertebra slips forward on the one below it. Both conditions can cause back pain by disturbing biomechanics in the back or by pinching a nerve as it leaves the spinal column. About 6% of the general population has spondylolysis. Spondylolysis is the most common cause of back pain in adoloescent athletes.

Spondylolysis

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Causes

Spondylolysis can be caused by:

  • A congenital defect in the spine, which usually appears a few years after birth
  • Acute trauma to the back
  • Chronic overextension with or without sidebending of the back as from certain sports and activities
  • Hamstring tightness or muscle imbalance
  • Degenerative conditions of the spine
  • Cerebral palsy—less common

Risk Factors

A risk factor is something that increases your chance of getting a disease, condition, or injury.

  • Playing sports such as:
    • Gymnastics
    • Football, especially the offensive line
    • Diving
    • Wrestling
    • Weightlifting
  • Improper athletic or exercise technique
  • Adolescent growth spurt

Symptoms

Symptoms may include:

  • Pain across the lower back
  • Spasms in the back and hamstring muscles
  • Pain radiating down the leg

However, many people with spondylolysis have no symptoms at all.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

  • X-rays—a test that uses radiation to take a picture of the spine to look for defects and/or fractures.
  • CT scan—a type of x-ray that uses a computer to make pictures of bony structures inside the back .
  • SPECT—single photon emission computed tomography is a very sensitive test that may be used.
  • MRI scan—– a test that uses a very strong magnetic field and radio waves to make pictures of both soft tissue and bony structures inside the back.

Treatment

If you have no symptoms from the spondylolysis, no treatment is needed.

If you have symptoms, treatment may include:

Exercise Restriction

Do not do athletic activities for several weeks to several months. In general, this restriction should last until the symptoms are gone.

Back Brace

Your doctor may suggest that you wear a back brace to help relieve pain, 4-6 weeks of bracing may be required.. The brace should limit extension, or lordosis, of the lumbar spine.

Physical Therapy

To relieve the pain and prevent recurrences, a physical therapist can teach you:

  • Exercises to strengthen the back and abdominal muscles, which stabilize the spine
  • Proper exercise and sports techniques to help prevent overuse and further injury
  • In particular, hamstring stretches are important

Medication

The doctor may give you medications for pain relief.

Surgery

Surgrey may be indicated if there is a neurlogical injury, if there is high-grade spondylolisthesis (more than 50% slippage), or if medication, rest, activity modification, and physical therapy don't relieve the pain, surgery may be considered. Two procedures are usually needed:

  • Decompressive laminectomy— removal of excess bone and reparative tissue that is putting pressure on the spinal nerves.
  • Spinal fusion—fusing together of the two involved vertebrae to prevent further slippage of the vertebra and stabilize that area of the spine.

Prevention

To reduce your risk of getting spondylolysis:

  • Limit participation in certain sports to a reasonable amount. This will help prevent overuse injury.
  • Keep the abdominal and back muscles strong and the hamstring muscles supple.
  • Use proper equipment for your sport.
  • Warm up properly before exercising or playing sports.
  • Learn proper techniques for exercise and athletic activities.
  • Seek medical care for chronic back pain. Early vertebral stress fractures, particularly in adolescents and young adults, may heal with rest.

RESOURCES:

American Academy of Orthopaedic Surgeons
http://www.aaos.org

American Academy of Pediatrics
http://www.aap.org

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://www.coa-aco.org/

Healthy Living Unit
http://www.phac-aspc.gc.ca/pau-uap/fitness/

References:

American Academy of Orthopaedic Surgeons.

American Medical Association.

Bono CM. Low-back pain in athletes. Journal of Bone & Joint Surgery - American Volume . 2004;86-A(2):382-96.

Eddy D. Congeni J. Loud K. A review of spine injuries and return to play. Clinical Journal of Sport Medicine . 2005;15(6):453-8.

Herman MJ. Pizzutillo PD. Spondylolysis and spondylolisthesis in the child and adolescent: a new classification. Clinical Orthopaedics & Related Research . 2005;(434):46-54.

Low-risk stress fractures. American Journal of Sports Medicine . 2001 Jan.

Peer KS. Fascione JM. Spondylolysis: a review and treatment approach. Orthopaedic Nursing . 2007;26(2):104-11.

Sakai T. Yamada H. Nakamura T. Nanamori K. Kawasaki Y. Hanaoka N. Nakamura E. Uchida K. Goel VK. Vishnubhotla L. Sairyo K. Lumbar spinal disorders in patients with athetoid cerebral palsy: a clinical and biomechanical study. Spine . 2006;31(3):E66-70.



Last reviewed January 2008 by John C. Keel, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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