Spondylolysis Symptoms, Causes, Risk Factors and Treatments

Lumbosacral pain
Lumbosacral pain. Max Delson Martins Santos / Getty Images

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 interarticularis, causes a fracture. This stress often starts with participation in competitive sports, such as gymnastics, dance, and some types of soccer and football plays, and others. In these sports, the spine is repeatedly flexed forward, bent back or turned (rotated), which leads to mechanical stress.

The Pars - The Weak Link:

The vertebrae interlock to give the spinal column integrity and to limit movement.  This occurs at the facet joints. The facet joints are pieces of bone that emanate from the bony ring in back, in particular, an area between the side and center of the ring called the lamina.

It is the area between articular process and the lamina that makes up the pars interarticularis (or pars as it is often called for short,)

Who Gets Spondylolysis?

Spondylolysis occurs in four to six percent of the general 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.

The Medscape website reports that it occurs in 6.4% of white men, but only 2.8% of black men and 2.3% of white women, and 1.1% in black women. They also say that although a pars defect is much more common in boys than girls when a high-grade slippage (spondylolisthesis) is involved, girls are 4 times more common to get this injury.

In the general population, spondylosis tends to be attributed to factors that increase the curve of the low back, called lordosis. Obesity is one such factor. A 2006 study published in the European Spine Journal 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.

Spondylolysis Symptoms

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

Diagnosing Spondylolysis Symptoms

When diagnosing spondylolysis, doctors use X-rays, CT scans, MRIs, 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, including an oblique view.

Spondylolysis Treatments

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.


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