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Spondylolysis

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Updated September 18, 2008

What Spondylolysis Is:

Spondylolysis is an overuse injury in which repeated stress to a small, somewhat obscure area of bone in the facet joint, called the pars, causes a fracture. This stress is most often due to movement associated with certain competitive sports, such as gymnastics, dance, and some types of soccer and football plays, as well as others. In these sports, the spine is flexed forward, bent back or turned (rotated) many times, creating mechanical stress.

The Pars - The Weak Link:

The vertebrae of the spinal column interlock by means of the facet joints. The place on the facet joint where the two vertebrae meet is an area called the pars. The pars is small, and therefore, vulnerable to injury; it's a 'weak link.'

Who Gets Spondylolysis:

Spondylolysis occurs in four to six percent of the population. The number is much higher in young competitive athletes than in the general population, due to the stress placed on the spine during sports.

In the general population, it tends to be attributed to factors that increase the curve of the low back, called lordosis. Obesity is one such factor. A 2006 study looked at over 4,000 spondylolysis patients who were not young athletes and found that obesity and aging were associated with spondylolisthesis, an injury that happens when the fracture is accompanied with forward slipping of the vertebra.

Symptoms of Spondylolysis:

Symptoms of spondylolysis include lower back pain which is worsened with activity, especially hyperextension of the spine. Many times people with spondylolysis have tight hamstring muscles. Spondylolysis might also be present without any symptoms.

Diagnosing Spondylolysis:

When diagnosing spondylolysis, doctors use X-rays, CT scans and bone scans. Since the pars is located at an odd angle, standard X-ray views don’t always provide the images necessary for the diagnosis. Therefore, when using imaging tests to diagnose spondylolysis, multiple views may be taken. Several types of imaging tests may be used, with CT scans as the gold standard. As of 2007, forward-looking doctors and researchers suggest that MRIs may take the place of the combined use of CT and bone scan tests, especially in follow-up examinations.

Treatment for Spondylolysis:

Early diagnosis is key to getting back in action when you have spondylolysis. But doctors and researchers have yet to come to an agreement on treatment for the injury. In some clinical settings, for example at Children’s Hospital in Boston, treatment includes wearing a brace and receiving physical therapy to strengthen muscles that reduce lordosis, and to increase flexibility of pelvic floor muscles. Of course, all sports activity must be stopped during this time. Stubborn cases of spondylolysis, in which the bones do not heal, may be treated with electrical stimulation, and if conservative care fails, surgery.

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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