Spondylolysis

What Is Spondylolysis?

The term is derived from the Greek words spondylos, which means spine or vertebra, and lysis, which means a break or loosening. If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to shift out of place, a condition called spondylolisthesis.

Spondylolysis is a common source of lower back pain in adolescents, particularly those involved in athletic activities that place a lot of stress on the lower back or cause constant overstretching (hyperextending) of the spine, such as gymnastics, weightlifting, and football. It is seen more often in males than in females. Spondylolysis is seldom seen in patients under the age of five and is found in 5% of people over the age of seven. It is a common cause of back pain in children, and the most likely cause of back pain in patients under age 26, but rarely the only cause of complaints after age 40. * The defect also may be present in adults with no prior history of injury or sports participation.

The exact cause of spondylolysis is unknown. Some theories point to genetics as a factor, suggesting that those with thinner bones are more susceptible to breakage. Others propose that repetitive trauma to the lower back weakens the pars interarticularis. Spondylolysis also may be associated with conditions that cause instability of the spine, such as lumbar disc degeneration or narrowing of the area where the nerve roots exit the spinal column (the neural foramina).

What Are The Symptoms Of Spondylolysis?

• Pain that spreads across the lower back; often feels like muscle strain
• Pain worsens with physical activity, particularly during hyperextension
• Hyperlordosis (increased inward curvature) of the lower back
• Tightening of the hamstring muscles (those in the back of the leg)
• Neurogenic/radiating pain (burning/shooting pain down the leg)

How Is Spondylolysis Diagnosed?

How Is Spondylolysis Treated?

Spine surgery is typically considered only after conservative therapies fail to adequately relieve symptoms over a significant period of time, or if evidence of nerve involvement, such as numbness or tingling, muscle weakness or bowel or bladder impairment, develops.

Surgical procedures that may be recommended for the treatment of spondylolysis include:

• Spinal decompression, a procedure in which bone is removed to eliminate nerve pressure
• Spinal fusion, a procedure in which bone graft material is placed between vertebrae to join – or fuse together – the vertebrae to restore spinal stability

The procedures are typically performed together as part of the same surgery, the overall goal of which is to remove the source of irritation and inflammation and restore the stability of the spine.

The benefits of spine surgery, however, must be weighed against the risks. Discuss with your surgeon the risks and benefits of surgery, and the potential results of operative versus non-operative treatment.

* Borenstein DG, Wiesel SW, Boden SD. Low Back Pain: Medical Diagnosis and Comprehensive Management. Philadelphia, PA:W.B. Saunder’s Co.;1995.