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Spondylolysis Treatment

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Updated April 16, 2014

Early diagnosis is the key to getting back in action when you have spondylolysis. Aside from that, doctors and researchers have yet to reach an agreement on the best way to treat spondylolysis.

At Children's Hospital in Boston, most patients are adolescent and young adults who train seriously in at least one sport. There, patients are on the sidelines for about 4 to 6 weeks or until their pain, especially when they extend the spine, is gone. During that 4 to 6 weeks, for 23 hours per day, patients wear a brace that prevents extension of the spine. The brace helps to reduce lordosis of the lumbar spine, and helps the bone in the area of the injury -- i.e. the pars -- to heal. Also during this time, patients go to physical therapy to help strengthen muscles that keep the spine from hyperextending, and to develop flexibility of the pelvic floor muscles.

Unfortunately for the athlete, activity limits placed on them during the healing and treatment phase of this injury may, in some way, seem even more painful than the injury itself. Still, activity during this time is limited to physical therapy exercises, stationary bicycling and certain swimming strokes. Anything that extends the spine is avoided.

After 4 to 6 weeks, the patient with spondylolysis is re-evaluated for spinal stabilization, and degree of pain. If pain is still present, the wearing of the brace and the physical therapy exercise continues.

In 4 months, healing is again assessed, this time by means of an exam and a CT scan. Here doctors are looking to see if and how well the bone at the pars has healed. If the test reesults show a bony union of the pars, and/or if the athlete is pain-free, the athlete is then allowed to fully return sports. She or he can also start gradually letting go of the brace.

While wearing the brace and doing physical therapy exercises is usually enough to heal spondylolysis and allow the athlete to return fully to sports, in about 22 percent of the cases, something else is needed. Electrical stimulation of the bone in the area of the injury is a procedure that has shown promise for this. In 2007, electrical stimulation is being tested at the Children's Hospital Boston, to see how effective it is as a treatment for spondylolysis, specifically to help the bone at the pars heal.

The final option, surgery to stabilize the spine, usually takes the form of a lumbar fusion, and is tried only after all conservative care procedures have proven ineffective. After surgery, patients are put in a cast or brace for at least 3 months, possibly up to 6 months. There will be no sports for a year after surgery. For those who play contact sports, there are no guarantees of returning to the field at all.

Sources:

Sonne-Holm, S., Jacobsen, S., Rovsing, H.C., Monrad, H., & Gebuhr, P. Lumbar spondylolysis: a life long dynamic condition? A cross sectional survey of 4141 adults. Eur Spine J, Nov 22 2006.

Micheli, L. M.D., Curtis, C. Stress Fractures in the Spine and Sacrum. Clin Sports Med 25 (2006).

Interview with Dr. Lyle J. Micheli, M.D. March 2007.

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