The Stress Fracture Spondylolysis

Spondylolysis is a word that is used to describe a condition where there is a stress fracture in a specific region of the spinal column. This region of the spinal column, called the pars interarticularis, connects adjacent vertebrae in the spine. When a doctor says you (or your child) has spondylolysis, they are saying this is a stress fracture (or stress reaction) in the vertebrae. 

Cause of Stress Fractures in the Spine

The are two primary sources that are risk factors for the development of spondylolysis. These include:

• Genetics: Some people are predisposed to the development of stress fractures in this particular location of their spine. This may be the result of the shape or the strength of the bone, the alignment of the vertebrae, of the rate of growth during childhood and adolescence. 
• Sports Activities: Certain specific sports activities make the finding of spondylolysis more likely, particularly sports that require hyperextension (bending backward) of the lumbar spine. These sports include gymnastics and diving. In these adolescent athletes, spondylolysis may be found in as many as 40% of participants of these high-risk sports.

Signs of Spondylolysis

Many young athletes have no symptoms, despite having findings of a stress fracture on imaging tests. When young athletes do have symptoms, the most common signs include:

• Low back pain (sometimes radiating into the buttock or thigh)
• Pain with the extension (bending back) of the spine
• Tight hamstring muscles

Children or adolescents suspected of having a stress fracture in their spine may need imaging tests. In an effort to minimize exposure of young patients to radiation from some of these tests, your treating physician may recommend starting with simple treatments first to see if they are effective. Given that noninvasive treatments are almost always recommended in the early stages of this condition, often imaging tests are withheld initially and saved for patients who don't improve with simple treatments.

When tests are performed, typically x-rays will be the first test obtained. X-rays are useful to assess the alignment of the spine and ensure the stress fracture has not caused any problems with spinal alignment. Other tests often used include CT scans, MRIs, and bone scans.

Spondylolysis can be asymptomatic, or it can be quite painful. When the condition is bilateral (occurs on both sides of the spine) it can cause a condition called spondylolisthesis. In this condition, a vertebral body can "slip" forward over the vertebrae directly below. The reason this occurs is that the normal structures that connect adjacent vertebrae are damaged from the stress fracture, and therefore the spinal column becomes unstable.

Treatment of Spondylolysis

As mentioned, most often treatment consists of noninvasive measures. In early stress fractures and stress reactions, there is healing potential for spondylolysis. The critical aspect of successful treatment is adequate rest from aggravating activities. In order to ensure the bone is sufficiently rested, some physicians will recommend a brace to limit the forces on the affected bone. 

Physical therapy can be a useful means to help improve mobility and increase strength. Medications such as NSAIDs, anti-inflammatory medications, can be helpful in relieving pain. Only in unusual circumstances is surgery needed to repair a stress fracture in the spine. Surgery is typically reserved for patients who develop a progressing slip, or spondylolisthesis, of the spinal column.