Spondylolysis (spon-dee-low-lye-sis) is a defect in one of the bones (vertebrae) that make up the spinal column. The defect is located in the area of the vertebra called the pars interarticularis, which is the bony ring through which the spinal cord passes. Spondylolysis is one of the most common causes of low back (lumbar) pain in adolescents. The most common locations for spondylolysis are the fourth and fifth lumbar vertebrae.
This defect most often represents a stress fracture caused by overuse in athletic children and teens. It is most common in sports that involve repetitive extension and loading of the low back such as gymnastics, diving, volleyball, softball pitching, weight lifting and football.
In about 5% of the population, spondylolysis develops gradually during normal growth. The defect is formed when the maturing bone fragments fail to unite normally.
Spondylolisthesis (spon-dee-low-lis-thee-sis) occurs when the spondylolytic defect weakens the vertebrae to the point where it is unable to maintain its proper position with respect to the vertebrae below it, and starts to shift or slip out of place. Most slips can be treated without surgery. Rarely, the slip is large and surgery may be necessary to correct the condition.
Slippage tends to occur during periods of rapid growth, usually during the adolescent growth spurt. Trauma is a rare cause of slippage.
The symptoms of spondylolysis and spondylolisthesis are very similar. The main symptom is pain in the low back which is worse with spine extension and with impact activities such as running and jumping. The pain may radiate to the buttocks and thighs. Muscle spasms often occur in response to the injury. These spasms can make the condition more painful and cause awkward posture and gait.
Your doctor will review your symptoms and
examine your back to assess range of motion, tenderness of the vertebrae
and tightness or spasm of the overlying muscles. An x-ray may identify
spondylolysis, but it is not the most sensitive test so it can miss some
subtle defects. Therefore, if your symptoms and physical examination
suggest spondylolysis but the x-ray does not show a defect, your doctor
may recommend a bone scan or CT scan, which are more sensitive tests for
Pain is a sign of injury, stress or overuse. If pain does not resolve after a couple days of rest, consult your physician. The sooner an injury is identified, the sooner proper treatment can begin. The result is shorter healing time and faster return to sport.
Your doctor will recommend a period of rest from all sports and activities to allow the stress fracture to heal. A back brace may be prescribed to limit spine movement which helps to relieve pain and may promote healing. Ice and anti-inflammatory medications such as ibuprofen may help reduce back pain that is not relieved with rest and bracing.
Once the initial healing period is over and the pain has subsided, your doctor will prescribe a course of physical therapy to include core strengthening, hamstring stretching and posture training, with gradual progression to sports-specific activities. This strengthening and stretching program is designed to reduce tension on the injured vertebra and stabilize the lumbar spine. This helps reduce the risk for re-injury.&
For spondylolisthesis, periodic x-rays may be performed to evaluate whether the vertebra is continuing to slip. Most cases of spondylolysis and spondylolisthesis resolve with rest and physical therapy, and athletes are able to return to their sport with no restrictions. For the rare cases that do not respond to this treatment, surgery may be necessary for relief of symptoms.
Returning to Activities & Sports
The goal is a return to sports or activities as quickly and safely as possible. If you return to activities too soon or you play with pain, the injury may worsen. This could lead to chronic pain and difficulty with sports. Return to sports or activities is determined by how soon the injured area heals and how well you progress in physical therapy, not by how many days or weeks it has been since the injury occurred. For most people with spondylolysis and spondylolisthesis, return to activity is possible within two to four months.