What is Spondylolysis?
Although it’s not as common as spinal stenosis or a herniated disc, spondylolysis is near the top of the list of conditions that can cause lower back pain. This spinal condition is relatively common, affecting approximately one out of 20 people. You may also hear it referred to as a stress fracture or pars defect.
Learning about spondylolysis can help you better understand the factors that could be behind your back pain. In this article, we’ll provide a detailed overview of spondylolysis, including modern treatment options for this condition.
What is Spondylolysis?
Spondylolysis is a stress fracture in a vertebra, which is a bone in the spinal column. The fracture occurs at the point where the vertebra connects to the vertebra above it, known as the pars interarticularis.
The pars interarticularis is a thin piece of bone that links the upper and lower segments of the facet joints. It connects the vertebrae and facilitates the movement of the spine.
The fracture in the pars interarticularis can allow a vertebra to move out of its usual position and press against, or compress, the spinal cord. This condition is called spondylolisthesis. Spondylolisthesis can cause several symptoms, with lower back pain being the most common.
Spondylolysis isn’t rare, affecting an estimated 3% to 7% of Americans. Many of the patients who are diagnosed with spondylolysis are younger than traditional spinal patients. In fact, in one orthopedic series, spondylolysis accounted for 47% of cases of acute lower back pain in teen athletes.
What Causes Spondylolysis?
Spondylolysis is rooted in a weakness in the pars interarticularis. The exact cause of a weakness in the pars interarticularis isn’t known.
With that said, factors that can influence the weakness in the vertebrae that characterizes spondylolysis include:
- A genetic defect
Genetics are believed to play a role in some cases of spondylolysis. Some children are born with this spinal condition.
- Overuse
Repetitive spinal trauma may also lead to spinal trauma. This commonly occurs in young athletes who frequently stress the spine. In two prospective studies, the incidence of lower back pain in athletes with spondylolysis was 72.5 % in high school rugby players, 80.5% in college football players, and 79.8% in high school football players.
Symptoms of Spondylolysis
The good news is that many people with spondylolysis remain asymptomatic. Asymptomatic patients have no symptoms and are usually unaware they even have spondylolysis.
When the spondylolysis does cause lower back pain, it usually spreads across the lower back. Spondylolysis pain often feels like a muscle strain and is generally exacerbated by exercise or vigorous activities.
In adolescent patients, spondylolysis symptoms often appear during growth spurts. This makes the most common age of diagnosis for teenage patients with spondylolysis 15 to 16.
Comparing Spondylolysis to Related Conditions
Spondylosis vs Spondylolysis
Spondylosis and spondylolysis are often confused, and it’s easy to see why. The names of these spinal conditions are very similar. But, each is a distinct ailment with different causes and symptoms.
The spondylosis diagnosis is used for degenerative osteoarthritis of the spine. With this condition, the cartilage that protects the ends of the vertebrae breaks down. As a result, the space between the vertebrae shrinks.
Spondylosis may also involve age-related degeneration of the spinal discs and bone spurs. This condition differs from spondylolysis, which specifically involves a stress fracture in the pars interarticularis.
Spondylolisthesis vs Spondylolysis
We’ve already mentioned spondylolisthesis and how it can result from spinal instability caused by spondylolysis. Similar to spondylosis, spondylolisthesis is commonly confused with spondylolysis. Additionally, spondylolysis can often cause spondylolisthesis, which further adds to the confusion.
Ultimately, spondylolisthesis involves vertebral misalignment due to spinal instability, while spondylolysis is a stress fracture of the pars interarticularis.
How is Spondylolysis Treated?
Most cases of lumbar spondylolysis are resolved with non-surgical treatment methods. Non-surgical spondylolysis treatment often involves lifestyle modifications, medications, and physical therapy.
Spondylolysis is a common injury in young athletes, namely those who are involved in sports that involve spinal hyperextension. So, physicians generally recommend that spondylolysis patients take a break from sports to give the spine time to heal.
Simple over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can often relieve mild spondylolysis symptoms.
Spondylolysis Physical Therapy
Physical therapy is one of the most effective non-invasive treatment options for spondylolysis. Your physical therapist can help you regain a high quality of life and safely go back to your usual activities.
The goals of physical therapy for spondylolysis are to:
- Help you manage lower back pain with methods including heat/ice therapy, electrical stimulation, and physical manipulation.
- Help you adopt lifestyle changes that will benefit your recovery process. These changes may include losing excess weight, starting a new exercise routine, and improving your posture.
- Improve and correct your body mechanics to prevent pain with day-to-day activities.
- Teach you stretching and strengthening exercises. These exercises can bolster the muscles that support the spine and alleviate muscle tension.
Spondylolysis Exercises to Avoid
In general, patients with spondylolysis should try to avoid all high-impact activities, such as running, as well as activities that put added stress on the lower spine. Heavy lifting, football, diving, and competitive swimming can all strain the lower spine.
With spondylolysis exercises to avoid in mind, it’s important to stay active with spondylolysis. Physical activity improves blood flow to the damaged and irritated spinal tissues, which facilitates the healing process. Additionally, gentle exercise will help you maintain muscle strength and mobility throughout your recovery.
Is It Possible To Prevent Spondylolysis?
Many patients, especially young athletes, are eager to avoid spending time on the bench due to spondylolysis. While genetic factors that may make you more susceptible to spondylolysis can’t be altered, certain tactics may help you prevent this spinal condition.
First off, consider a sports injury prevention program, which may be available from your local physical therapist. This type of program focuses on safely building muscle strength and increasing flexibility. Together, strength and flexibility can help prevent excess strain on the spine.
Additionally, avoiding repetitive motions that strain the back can help prevent lumbar spondylolysis. Unfortunately, this may not be possible in specific sports, such as gymnastics and weightlifting. Athletes who are predisposed to spondylolysis should consider talking to their coaches about their unique needs.
As a general rule of thumb, practicing proper posture can help avert spondylolysis and a host of other spinal conditions. Try to be mindful of your posture while you sit, stand, and lift heavy objects. Keeping your spine straight with your shoulders back and head levels allows for proper spinal alignment.
Treatment For Severe Spondylolysis
In moderate to severe spondylolysis cases that don’t respond to conservative treatments, spondylolysis surgery may be required. There are a few different surgical approaches that your physician may recommend.
Surgical Repair
Surgery may be implemented to repair the spinal stress fracture. During this type of procedure, the surgeon will likely use a titanium screw to secure either side of the fracture together. For additional support, your surgeon may also place bone graft material in the affected area.
Spinal Decompression
Patients with spondylolysis and nerve compression from spondylolisthesis may benefit from spinal decompression surgery. Spinal decompression involves removing a portion of the defective vertebra that’s compressing the spinal nerve.
Typically, spinal fusion surgery is performed following the decompression procedure to stabilize the spine. Spinal fusion involves placing bone graft material in between the affected vertebrae. This process, over several months, permanently fuses the targeted vertebrae.
Unfortunately, while spinal fusion can successfully prevent spinal instability after decompression surgery, it also eradicates the independent motion of the vertebrae. This leaves patients’ mobility seriously compromised and increases the risk of degeneration in the neighboring vertebrae.
With these downsides (among others) in mind, many modern spondylolysis patients look for spinal fusion alternatives. Recently, an advanced alternative to spinal fusion, the TOPS™ posterior arthroplasty procedure, has gained prevalent in the United States. Having been approved and successfully used for years in Europe and other countries, the TOPS™ System provides better clinical outcomes than fusion while preserving the patient’s full range of back motion.
Back pain is one of the world’s most common and debilitating medical conditions. As pioneers of advanced surgical treatments for spinal disorders, we at Premia Spine encourage anyone suffering from back pain, including spondylolysis pain, to learn about all the treatment options available today.
