Spondylolysis

What is Spondylolysis?

Spondylolysis is a break or fracture in the arch in the posterior segment of the vertebra. The lumbar vertebrae stack one upon the other with the somewhat hook-shaped posterior portion forming joints (facets) with the vertebrae above and below. The vertebrae are stabilized by the many ligaments and intervertebral discs in the spine, as well as the bony bridge between the anterior and posterior sections of the vertebral body. The break may be the result of a traumatic episode, a degenerative process, or repeated stress across the area (stress fracture). There is a genetic predisposition. There is a high incidence in athletes who undergo repeated or constant hyperextension of the lumbar spine (bending backwards) such as football linemen and gymnasts. Spondylolysis typically occurs in adolescent or preadolescent children.

Most spondylolysis fractures are not recognized at the time of occurrence, so the term usually describes chronic nonunion of a previous fracture that is visible on x-rays.

How is it diagnosed?

History: Pain may be acute (rare traumatic fracture). Old established lesions are rarely symptomatic. There may be limited motion. Pain may be felt deep within the low back and may radiate to the buttock and thigh on the affected side and is relieved by rest.

Physical exam: A complete musculoskeletal and neurological back exam is necessary to rule out any underlying pathology and nerve irritation. The neurological exam is usually normal unless there is the infrequent spinal nerve irritation.

Tests: The diagnosis is most often made with lumbar spine films taken in the oblique angle. Because the fracture may be found on only one side of the vertebra, oblique views are required from both sides. Lateral views will rule out spondylolisthesis. Bone scans will be necessary in older individuals to determine the age of the defect (fracture). If the bone scan is normal, the fracture (nonunion) is at least years old. Three to five percent of the population has spondylolysis as an asymptomatic incidental finding on x-ray.

How is Spondylolysis treated?

Acute fractures are treated with immobilization from a semi-rigid brace and cessation of all activities that cause flexion and extension of the lumbar spine. Conservative treatment to control pain including heat, physical therapy, and medication is indicated in non-acute but symptomatic fractures. Surgery is used with children and adolescents if there is evidence of evolving spondylolisthesis. Education of the individual should include prevention of injury, and muscle strengthening programs should be included when the acute symptoms have subsided.

Medications

Soma (Carisoprodol)

What might complicate it?

Bilateral (both sides of the vertebra) defects have a chance of leading to a sliding forward of the vertebrae (spondylolisthesis), which does not occur with unilateral defects.

Predicted outcome

Acute fractures that are recognized and treated most often heal without complication. Non-acute defects are usually asymptomatic and do not correlate with back symptoms.

Alternatives

Degenerative conditions of the spine such as disc disease or arthritis may induce similar patterns of pain and spasm.

Appropriate specialists

Orthopedic surgeon (for acute fractures).

Last updated 22 June 2011


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