Spondylolysis – Everything you Need to Know

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What is Spondylolysis?

Spondylolysis is a painful condition of the spine. It is a stress fracture of the pars interarticularis bone on the posterior side of the spine. The pars interarticularis is the most vulnerable and the weakest part of the spine, especially in younger patients whose bones are still developing. As a result of this fracture, the vertebral body can slip forward, which is known as Isthmic spondylolisthesis. Spondylolysis can sometimes be confused with Spondylolisthesis, which is an altogether different condition.

Spondylolysis is also known as a “pars defect” because it affects the pars interarticularis, a small spinal bone. This is a fairly common disorder that affects one out of every 20 people. This condition can be caused by traumatic impacts from repetitive hyperextension of the spine due to car crashes, a fall, sports like gymnastics or genetic/degenerative changes to the bone. The treatment is mainly targeted towards symptom management. Surgical intervention would only be recommended if there is extreme nerve compression, progressive neurologic damage, or intractable pain.

Symptoms of Spondylolysis

Spondylolysis doesn’t always show symptoms. The majority of people with age-related spondylosis have no symptoms. Some people experience symptoms for a brief period of time before they disappear. A sudden movement can often trigger the symptoms.

Stiffness and mild pain are common symptoms that get worse after certain movements or long periods of inactivity, such as sitting for a long time. In most cases, the pain does not interfere with daily activities. If the problem persists, you may seek medical help. Some of the more serious symptoms include:

  • Back pain
  • Stiffness in the lower back region
  • Weakness in the legs or hands
  • Muscular spasms
  • Difficulty in walking
  • Loss of balance
  • Loss of bladder or bowel control
  • A grinding feeling when moving the spine

Causes of Spondylolysis

When you have spondylolysis, a section of your vertebra called the pars interarticularis is particularly weak. The facet joints, which link the vertebrae directly above and below to form a functioning unit that enables the spine to move, are connected by this thin piece of bone.

When extreme forces are applied to this weak area of bone, a stress fracture may form, particularly in patients who are not yet skeletally mature. Spondylolysis is caused by repetitive hyperextension or rotational forces, such as those in gymnastics or baseball. Pars stress fractures are common in the younger population, with an estimated 5-7 % of adolescents suffering from them. Fortunately, this fracture recovers in 6-8 weeks with proper rest and abdominal core strengthening.

Spinal tumors, trauma, and genetics are some of the other causes of spondylolysis. In some cases, the cause of spondylolysis is unknown which is known as idiopathic.

Diagnosis of Spondylolysis

Spondylolysis is a condition that causes long-term, localized low-back pain. An X-ray can be used to diagnose a stress fracture. Additional imaging may be necessary if pain continues despite rest and physical therapy. For a definitive diagnosis, the doctor may need to order a CT scan, MRI or nuclear medicine bone scan with SPECT of the lumbar spine.

Complications

Based on some symptoms and initial changes, a doctor can determine what type of spondylolysis a person has. According to research published in the BMJ in 2007, these same issues can develop as complications in other people. These changes can cause the other symptoms to become worse. The location of symptoms such as pain can be determined by which part of the spine is affected by spondylosis.

You can find examples of these types of complications below:

Cervical radiculopathy:

Changes in the bone or disc can cause nerves in the spine to become pinched, resulting in numbness, shooting pain and hypersensitivity.

Scoliosis:

According to a research, scoliosis in adults can be related to degeneration of the facet joints.

Spinal stenosis:

This is a condition in which the canal that carries the nerves of the spinal cord narrows. Symptoms include numbness or weakness in the hands and feet, as well as pain in the neck or back that may spread down the leg.

Cervical spondylotic myelopathy:

In this condition, the spinal cord is either compressed or squeezed. Symptoms of this condition include loss of coordination in the hands, numbness and pain in the limbs, imbalance and trouble walking, and bladder issues in the later stages.

Treatment

Treatment for spondylolysis focuses on pain management and helping you to return to your everyday activities. In most cases, this disorder does not place you at risk of spinal cord injury or nerve damage.

Nonsurgical treatments for spondylolysis are commonly used by healthcare providers to treat this condition. Your treatment plan might include physical therapy and activity modification medications. Doctors only recommend surgery in rare cases.

Non-surgical Treatment Options

The main goals of treatment are to relieve your pain and discomfort, allow the fracture to heal and help you to return to your everyday activities. To feel complete relief, you may need to follow the treatment plan for a few weeks to a few months. Some of the non-surgical treatment options are:

  • Rest: Rest for a while. Take a break from all sorts of strenuous activities and sports.
  • Medications: Your doctor may prescribe over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin®) to help relieve inflammation and pain. If required, your doctor may recommend stronger medications.
  • Bracing: Occasionally, a back brace is recommended by the doctor to help support the spine as the pars fracture heals.
  • Keeping physically active: Low-impact activities, such as walking or swimming, can help maintain stability and strengthen the muscles that protect the spine.
  • Steroid injections: To help alleviate pain, the healthcare provider injects steroid medication directly into the affected region.
  • Physical therapy: A physical therapist will teach you exercises to strengthen your muscles and increase your flexibility so that you can move without pain.
  • Improving posture: Slouching, for example, can cause your pain to worsen.

Surgery

Spondylolysis surgery is rare. The majority of the time, nonsurgical treatments help patients feel better. Surgery is only suggested by the doctors when the symptoms are persistent and serious and if no other treatment has helped.

Surgery may be required if pinched nerves cause severe weakness, numbness, or loss of bowel or bladder control, and if the damage is likely to worsen without surgery. The type of surgery required will be determined by the problem and its location. Imaging technology, such as X-rays, may help a doctor locate the affected areas.

Surgeons remove scar tissue from the fracture region during pars repair. They use a piece of bone from another part of the body to support the sides of the fracture. After surgery, you will almost likely need therapy to help you regain full function.

Bottom Line

Spondylosis is a common condition that affects the spine, and most of the people are likely to develop it as they age. Many individuals will not experience any symptoms, whereas some will experience only mild symptoms.

A doctor may prescribe surgery if the pain is extreme and if weakness and numbness are affecting a person’s quality of life.