Overview of Spondylolysis Spinal Injury

Back Pain
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Spondylolysis is an overuse injury in which repeated stress to a small area of bone on the vertebra, known as the pars interarticularis, causes a fracture. The condition is often associated with competitive sports activities such as gymnastics, football, soccer, and even competitive dancing in which the spine is repeatedly flexed forward, bent backward, and rotated.

Pars Interarticularis and the Structure of the Spine

The vertebra of the spine interlock to give the spinal column integrity and to limit the range of motion. The interlocking occurs at the facet joints. These are the protrusions of bone emanating from the from the back of each vertebra like wings, interlocking one into the next at the spine moves or rotates. When a person bends forward, the facet joints separate; when the person bends back, the joints come together and restrict movement.

The pars interacticularis is the area of bone that lies in between the point of articulation (where the facet joints meet) and the center line of the vertebra known as the lamina.

Spondylolysis Risks

Spondylolysis occurs in four to six percent of the U.S. population, primarily in young competitive athletes. While younger men are three times more likely to get spondylolysis than younger women, younger women are four times more likely to get spondylolisthesis, a condition in which a vertebra slips forward onto the one immediately beneath it.

Spondylolysis is most likely to occur in persons who have an excessive inward curvature of the spine, known as lordosis. Obesity can also contribute as it places additional stress on the vertebral segments themselves.

While older age is not typically associated with spondylolysis, it is with spondylolisthesis as the gradual deterioration of bone significantly increases the risk of slippage.

Symptoms and Diagnosis

Symptoms of spondylolysis include lower back pain which worsens with activity, especially when standing or hyperextending the spine. People with spondylolysis also tend to have tight hamstring muscles due to spasms that stiffen the back and alter a person's posture and gait.

The pain may either be direct or referred and be felt in the back, legs, thighs, or buttocks. Spondylolysis may also cause no pain symptoms but rather be experienced with muscle weakness, stiffness, or spasms.

Spondylolysis is typically diagnosed with imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) scans. Because the pars interarticularis is positioned at an oblique angle, it is often difficult to see with a standard X-ray.

Treatment

Early diagnosis is key to successfully treating spondylolysis. With that being said, doctors are sometimes split on what the appropriate course of treatment may be.

In most cases, doctors will endorse a conservative approach involving the use of back braces and physical therapy to strengthen muscles and reduce lordosis. It's a slower approach that may sideline you for a while but one that almost always returns positive results in younger patients.

Severe fractures or those that fail to heal may be treated with electrical stimulation or require spinal surgery such as a lumbar fusion.

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Article Sources
  • Hirpari, K.; Butler, J.; Dolan, R. et al. "Nonoperative Modalities to Treat Symptomatic Cervical Spondylosis." Advances Orthoped. 2012; 2012:294857. DOI: 10.1155/2012/294857.
  • Middleton, K. and Fish, D. "Lumbar spondylosis: clinical presentation and treatment approaches." Curr Rev Musculoskelet Med. 2009; 2(2):94-104. DOI: 10.1007/s12178-009-9051-x.