Why does it occur?

Spondylolysis is a unique type of stress fracture in the spine called the pars interarticularis.  Although sometimes this occurs for no obvious reasons, the fracture most commonly occurs due to repetitive hyperextension of the spine, commonly seen in lineman in football or gymnasts.  If continued trauma occurs, the end result is a fracture or nonunion (bony separation) of the pars leading to an increased chance of back pain and spinal instability (Spondylolisthesis).

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Symptoms:

Symptoms of Spondylolisis vary greatly.  Some patients present with tight hamstrings but no appreciable pain, while others have significant discomfort, instability, or neurological symptoms.  In general, symptoms are typically worse with activity and better with rest. Patients may present with either one or both pars interarticularis fractured. If both sides are involved, patients have a higher risk for developing instability, Spondylolisthesis, and associated symptoms.

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Diagnostic Testing:

An X-ray is typically ordered during your office visit with Dr. Lee.  The X-ray is a valuable tool to assess the bones in your spine and see the degree of separation/fracture if any or the degree of vertebral slippage.  Dr. Lee will assess for any mal-alignment, arthritis spur formation, disc or joint space narrowing, or other bony pathology.  Dr. Lee may also order a CT and/or MRI if your symptoms are significant, failing to improve over time, significant slippage, increasing degree of slippage, or if you have any signs of weakness.  Sometimes a bone scan may also be ordered to help determine how acute or chronic or how active or latent the Spondylolysis is. 

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Treatment Options:

Treatment options will vary depending on the severity of symptoms and associated exam findings. Pain is often relieved with rest from the offending activity or sport. If the bony separation (Spondylolisis) is painful, if the malalignment (Spondylolisthesis) is acute or increasing in degree, Dr. Lee may suggest a brace to help stabilize your spine  This brace is often worn for up to 3 months.  Physical Therapy may be advised. PT is an important aspect of treatment to strengthen the surrounding musculature of the spine, help alleviate muscle spasms, and decrease pain. Typically heat is applied at the start of the PT visit and ice is applied at the end to ward off inflammation.

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Surgical Treatment:

The majority of patients with Spondylolisis and Spondylolisthesis, especially those with less than 50% slippage, do not require surgical intervention.  Surgery may be advised for patients with a recalcitrant fracture, persistent neurological symptoms, or significant instability and high-grade vertebral slippage.  Surgery may also be advised if the nerve compression becomes severe or if the patient fails to improve with the above non-operative treatments.

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*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

 

*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.