Definition and Overview
Spondylolysis is a developmental defect that affects either the lumbar vertebrae or the thoracic vertebrae, although cases affecting the former are more common. It causes severe low back pain and can greatly impair mobility, leading to a reduced quality of life. The pain is triggered by small breaks or fractures that affect various parts of the vertebrae; over time, these breaks cause a general weakening of the vertebrae and may eventually progress into a more severe condition known as spondylolisthesis, wherein one or more of the bones shift out of their position. When this occurs, there is a possibility for the bones to press on the nerves, causing severe pain and requiring surgical correction.
Cause of Condition
Spondylolysis is triggered by the weakening of the pars interarticularis, a small part of the vertebrae responsible for linking the upper and lower segments of the joints that regulate spinal movement. Certain risk factors that increase the risk of developing the condition include the following:
Genetics – Some people are born with abnormally thin vertebral bones making them more susceptible to breaks or stress fractures. Some, on the other hand, are born with a genetic defect in their L4 vertebrae. Regardless of the specific genetic condition they have, their inherited vulnerability is often aggravated by growth spurts, which can further encourage slippage of the vertebral bones.
Wear and tear – Overusing the vertebral bones by engaging frequently and for a long time in certain sports or activities put a significant strain on the lower back causing the spinal bones to become overstretched or overextended.
Gender – Studies show that the condition tends to affect male patients more.
Age – Studies show a higher occurrence of this orthopedic condition among people aged between 14 and 26.
Some sports and activities are known to cause a higher risk of spondylolysis due to the nature of the repetitive body movements they require; these include:
In many cases of spondylolysis, the condition does not cause any noticeable symptoms, putting the patients in danger of developing spondylolisthesis as the bones get weaker or develop more stress fractures. Even then, some cases of spondylolisthesis remain asymptomatic for many years.
For those who experience symptoms, sufferers may feel:
- A tingling sensation
- Tightening of the muscles
Other symptoms also include:
- Sciatica, or weakening of the leg
- Abnormal back sway
In the majority of cases with hereditary causes, the individual first experiences symptoms during the teenage years because of the growth spurt that occurs during this time. This is the reason why many patients are diagnosed with this condition at ages 15 to 16.
The pain and other sensations associated with spondylolysis affect the lower back but may extend towards the buttocks. The pain is similar to that caused by a strained muscle. Patients also usually experience symptoms more when they have been walking or standing for a long time or when they engage in strenuous physical activities. Resting usually brings relief, but only temporarily.
When symptoms begin to present, the condition becomes easier to diagnose. Tests such as computed tomography or CT scan as well as magnetic resonance imaging or MRI scan are used to check for stress fractures and determine their location and severity, if there are any. These scans also effectively rule out other conditions that cause similar symptoms. Spondylolysis may also be diagnosed with the help of radiography scans and nuclear imaging tests.
Who to See and Types of Treatments Available
A person who is experiencing lower back pain or other symptoms that may indicate the presence of spondylolysis, may consult a general physician or an orthopedist, a medical doctor specializing in the diagnosis and treatment of orthopedic conditions.
Doctors use two main types of treatments for spondylolysis, namely surgical and non-surgical techniques. They usually provide non-surgical treatments a try first before prescribing surgery. The goal of non-surgical treatment is to relieve symptoms and prevent the onset of spondylolisthesis by protecting the patient from more stress fractures. Patients are also taught how to do their normal activities while also avoiding placing high stress on the lower back. Available treatments that do not require surgery include:
- Rest, especially from the activities or sports that are suspected to be the cause of the condition
- Brace or a supportive back device to stabilize the lower back during the healing process
- Physical therapy
- Exercise, starting with stretching and strengthening exercises followed by aerobic exercises when the patient is strong enough
- Steroid injections, which are more effective in reducing pain and inflammation in more severe cases
The most common medications involved in a treatment plan for spondylolysis are NSAIDs or analgesics, such as ibuprofen, aspirin, acetaminophen, and naproxen. These medications are proven effective in relieving not only pain but also inflammation that may accompany the symptoms. These are to be taken strictly as the doctor advised to avoid complications.
Self-help home remedies such as cold or hot packs may also help, but patients may also benefit from other forms of therapy, such as:
- Electric stimulation
- Hands-on therapy
On the other hand, surgical treatments are more commonly used for cases of spondylolisthesis, i.e. when slippage has already occurred and is continuously worsening. Surgery may also be an option if the pain caused by spondylolysis is severe and does not seem to respond to other forms of treatment. The two surgical procedures used for this purpose:
Posterior lumbar fusion – This is performed to fuse together two vertebral bones so they are more stable and less prone to breakage or slippage
Laminectomy – This relieves pressure off compressed nerves or herniated disks by removing the lamina from the vertebrae; as such, this type of surgery is only reserved for cases where nerve compression is also a problem
Surgical treatments are carried out by an orthopedic surgeon and require a long recovery period, during which the patient should avoid sports or other strenuous physical activities.
Earle JE, Siddiqui IJ, Rainville J, Keel JC. Lumbar spondylolysis and spondylolisthesis. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 49.
Spiegel DA, Dormans JP. Spondylolysis and spondylolisthesis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 671.6.