What is Spondylolysis?
Spondylolysis is a deficiency or defect in the vertebral joints of the spinal column. This defect can result in minor stress fractures or breaks in the vertebrae that causes weakening of the bones. Due to this, one vertebra slips out of its place on top of other (spondylolisthesis). Spondylolysis is a common cause of low back pain. Spondylolysis is an overuse injury. It is common in athletes who are involved in lot of bending the spine backwards and turning of the spine.
The stress fracture occurs in the pars interarticularis in the spine. Spondylolysis in both sides of the spine occurs in conjunction with spondylolisthesis. The fracture commonly occurs on the opposite side of the aggravating activity such as in case of a right handed thrower, the fracture occurs on the left side of the spine. Depending on the severity and duration of the injury, the pars defects can be divided into early, progressive, and terminal stages. Early stage pars defects usually heal faster resulting in re-union of the bone. One sided fracture heals faster than two or more fractures on each side. X-ray, CT scan, or MRI confirms the diagnosis. A bone scan or a Single Photon Emission Computed Tomography (SPECT) scan can give more accurate results. Fractures occurring at the L4 vertebra heal faster than fractures occurring at L5. It is imperative that diagnosis is made as soon as possible.
What can Cause Spondylolysis?
- Weakness in the pars interarticularis, which is a part of the vertebra.
- Hereditary factors.
- Repeated trauma.
Identifying The Symptoms of Spondylolysis
- Some patients don't feel any symptoms at all and are not aware of having this condition.
- Low back pain. It can be a one sided back pain.
- Increasing pain upon activities involving bending the spine backwards (extension).
- There may be an increase in lumbar curvature of the spine (hyperlordosis).
- Stiff hamstring muscles.
- The pain can be reproduced upon standing on the affected side and leaning backwards.
- Pain upon pressure over the site of fracture.
Treatment Options for Spondylolysis
- Rest should be taken from sports and other aggravating activities.
- The hamstring and gluteal muscles should be stretched.
- As the pain decreases, strengthening program of the core muscles of the abdomen and lower back should be started.
- Back braces can be used.
- NSAIDs such as ibuprofen and naproxen help in pain relief.
- Other stronger pain medicines can be used if required.
- Epidural steroid injections help in decreasing pain and inflammation.
- Physical therapy helps in flexibility and muscle conditioning.
- As the movements become pain free, the athlete can return to sport specific training.
- Changes in the training should be made accordingly in order to prevent recurrent injury.