Learn about spondylolysis symptoms, causes, and recovery time. Get insights on weightlifting with spondylolysis and find ways to manage this condition effectively.

Spondylolysis

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Iqra Mazhar

Overview

Spondylolysis is defined as a small fracture between two vertebrae in the spine. 
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Also known as pars defect or pars fracture, spondylolysis is a stress fracture of the pars interarticularis -&nbsp; the thin bone connecting two vertebrae. This is typically a consequence of repetitive trauma to a genetically predisposed person&#39;s developing undeveloped skeleton. The condition most commonly develops in the lumbar spine, but can also affect the thoracic and cervical regions. Approximately 90% of cases occur at the level of the L5 vertebra, with the incidence decreasing at higher lumbar levels<a href="#accordion">[4]</a>. 
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Spondylolysis affects 4% of children by age six and 6% by age fourteen, while the prevalence remains constant throughout adulthood<a href="#accordion">[4]</a>. Children and teens who play sports are at a higher risk of developing spondylolysis. The condition tends to be asymptomatic, but about 10% of those impacted experience symptoms<a href="#accordion">[4]</a>. Lower back pain is the most common spondylolysis symptom. In some cases, the crack in the vertebra can lead to spondylolisthesis as the vertebra slips out of place over the one below it. 

The majority of individuals do not require surgical treatment. Rest, medications, and physical therapy are most effective when started promptly. 
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Signs and Symptoms

Spondylolysis is primarily undetectable, but about 10% of those affected experience symptoms such as gradual onset, frequent axial lower back discomfort that worsens with exertion, lumbar hyperextension, and may or may not have a connection with a radicular component<a href="#accordion">[4]</a>. 
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The pain, characterized as a dull, aching sensation in the lower back, hips, and posterior thighs, may vary in intensity from mild to severe. If neurologic signs are present, they are most likely caused by spondylolysis with spondylolisthesis or other degenerative processes that end up resulting in neuroforaminal narrowing and spinal nerve impingements. The most prevalent manifestation of spondylosis is lower pain in the lower back. Typically:

<ul>
	<li>The pain radiates from the lower back into the thigh and hip muscles.</li>
	<li>There may be a muscle pull in or near the lower back.</li>
	<li>It worsens during vigorous physical activity and optimizes with rest or reduced activity.</li>
</ul>

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Specific individuals with spondylolysis have no signs or symptoms. These individuals may only realize they have it after an imaging test for a different reason. 
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Note: If your pain persists or makes it difficult to carry out everyday activities, contact a healthcare professional immediately. 
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Causes

Spondylolysis can be hereditary or acquired. Although the exact cause in each case is unresolved, it is generally caused by a stress-induced fracture of the pars interarticularis that continues as a non-union. It usually manifests itself in genetically predisposed children and teens with poor biomechanics, and those who take part in activities exposing them to repetitive microtrauma on the pars interarticularis.

The pars interarticularis are thin bone fragments that connect the two vertebrae. These connections allow the spine to move and bend. Anything that harms the pars interarticularis can cause them to break. These are known as pars fractures. The following are the most general causes of pars fractures: 
&nbsp;

<ul>
	<li>
	<h5>Overuse</h5>
	</li>
</ul>

Recurrent movements that put a strain on the lower back lead to vertebral deterioration. This damage can accumulate over some time and lead to a pars fracture. Physical work, engaging in contact sports, and frequently damaging the lower back can all harm the vertebrae.

<ul>
	<li>
	<h5>Growth Spurts</h5>
	</li>
</ul>

A few children and teenagers develop spondylolysis during a period of rapid development when their bodies are rapidly developing and modifying.

<ul>
	<li>
	<h5>Genetics</h5>
	</li>
</ul>

A few individuals have thinner vertebrae from birth. It increases their chances of experiencing a pars fracture. 
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There are currently no screening tests for spondylolysis. Doctors run tests based on the patient&rsquo;s symptoms. 
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Diagnosis

A diagnosis of spondylolysis is typically based on physical examination and imaging tests. The doctor will first obtain a detailed history from the patient, inquiring about their symptoms, past medical history, family history, and whether they play any sports. 

During the physical examination, the doctor will assess the back and spine for muscle spasms, area of tenderness, muscle weakness, and limited range of motion. They will also observe the patient&rsquo;s posture and gait. 

Imaging tests can help confirm the diagnosis. 
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<ul>
	<li>X-rays: These can detect a crack or stress fracture in the pars interarticularis region of the lumbar vertebra. The lesion presents as the classic &lsquo;collar on the Scotty dog&rsquo;. However, X-rays may miss the fractures within the first 2 weeks of the injury.</li>
	<li>CT: This is the test of choice for spondylolysis, especially if the X-rays are unable to detect the condition or the pain persists. However, due to the elevated incidence of spondylolysis in pediatric patients and fears about unnecessary radiation exposure, the MRI is usually selected as the following modern imaging technique if plain films are unfavorable.</li>
	<li>MRI Scan: MRI is highly effective at identifying bone marrow edema linked with acute pars interarticularis strain injury and detailing neural and soft tissue pathologies.</li>
	<li>SPECT Scan: The SPECT scan is a successful substitute for MRI in identifying acute stress fractures and assessing fracture acuity. However, it carries the possibility of concurrent radiation threats, which a doctor should avoid in the pediatric population. 
	&nbsp;</li>
</ul>

Treatment

The doctor will treat the discomfort along with other manifestations while the pars fracture heals. Based on which vertebrae were impacted and the severity of the fractures, treatment can last anywhere from a few weeks to some months.

The majority of spondylolysis patients, such as athletes, can be treated conservatively. In reality, patients with no symptoms whose condition comes to light unintentionally on imaging may continue to engage in the same amount of exercise without limitation. A doctor should consider conservative treatments if the patient presents with acute symptomatic spondylolysis as verified by SPECT-scan or MRI. These might involve the following: 
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<ul>
	<li>Rest</li>
</ul>

Taking some time off from athletic activities and other strenuous physical endeavors decreases spinal stress.

<ul>
	<li>Medicines</li>
</ul>

Over-the-counter NSAIDs decrease inflammation and alleviate pain. However,&nbsp; prescription painkillers should not be taken for ten days in a row without consulting with a medical professional.

<ul>
	<li>Corticosteroids</li>
</ul>

Corticosteroids are anti-inflammatory drugs. The doctor may recommend oral or injectable forms of the medication. 

<ul>
	<li>Physical Therapy</li>
</ul>

A physical therapist is a healthcare professional who can assist in optimizing the way the body moves. They will help manage symptoms, such as pain, stiffness, and discomfort that make it challenging to move around. A physical therapist will teach the patient activities to strengthen the muscles surrounding the spine. 

<ul>
	<li>Bracing</li>
</ul>

The doctor may recommend a back brace to assist in stabilizing the spine while the fracture heals.

<ul>
	<li>Surgery</li>
</ul>

Patients rarely require surgery for spondylolysis. However, if back pain does not improve after 6 months of nonsurgical treatment, or the patient experiences progressive neurologic symptoms (saddle anesthesia, refractory pain, bowel or bladder dysfunction), or develops severe spondylolisthesis of grade 3 or higher, surgical intervention will be required. 

During a pars repair surgery, the doctor performing the procedure can typically repair a pars fracture without requiring a spinal fusion (the joining of two vertebrae to form one bone). Titanium screws are used to secure the two sides of the fracture together and stabilize the spine. A bone graft is placed into the spaces between the vertebrae. These bones grow together with time. If nerve compression is present, the doctor may also perform a procedure to widen the spinal canal and relieve the pressure on the nerves. 

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Adjunctive treatments may also prove beneficial. These include:

<ul>
	<li>Treatment with ice and heat</li>
	<li>Steroid injections in the epidural space</li>
	<li>Massage</li>
	<li>Chiropractic or osteopathic manipulation</li>
	<li>CBT (cognitive-behavioral therapy)</li>
</ul>

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It may take as long as six months for a pars fracture to recover. The majority of individuals suffering from spondylolysis improve their symptoms as soon as they start therapy. 
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Note: Even if your symptoms improve quicker, stick to the treatment regimen as long as your healthcare professional or physical therapist recommends. It is critical to give your spine the time it requires to recover completely. Inquire with your healthcare provider about when you can resume athletic activities or strenuous physical activity. 
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In most cases of spondylolysis, the condition is not readily apparent and remains symptom-free for the patient&#39;s lifetime. However, individuals with spondylolysis may experience accelerated degenerative disc disease and spondylosis, which often occur as a result of aging. 

This can increase the likelihood of spinal stenosis and lumbar radiculopathies. Additionally, almost 50% to 75% of patients with bilateral spondylolysis may experience vertebral body slippage, which can lead to these harmful effects<a href="#accordion">[4]</a>. 

Possible surgical complications may include a failed fusion, infections, chronic persistent pain, neurological deterioration, and failed back surgery syndrome. 
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Some of the risk factors associated with spondylolysis include: 
&nbsp;

<ol>
	<li>Genetics</li>
</ol>

Spondylolysis can be hereditary. Therefore, a family history of the condition increases the risk. 
&nbsp;

<ol start="2">
	<li>Sports And Physical Activities</li>
</ol>

Sports that involve repetitive hyperextension of the lower back, such as gymnastics, football, weightlifting, and diving, increase the risk of spondylolysis. 
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<ol start="3">
	<li>Age</li>
</ol>

Spondylolysis is more common in children and adolescents, especially those who are involved in sports or physical activities. 
&nbsp;

<ol start="4">
	<li>Gender</li>
</ol>

Spondylolysis is more common in males than in females. 
&nbsp;

<ol start="5">
	<li>Body Weight</li>
</ol>

Obesity or being overweight can put additional stress on the spine, increasing the risk of spondylolysis. 
&nbsp;

<ol start="6">
	<li>Poor Posture</li>
</ol>

Poor posture can lead to increased stress on the spine, which can increase the risk of spondylolysis. 
&nbsp;

<ol start="7">
	<li>Previous Injuries</li>
</ol>

A previous injury to the lower back, such as a stress fracture or disc herniation, can increase the risk of developing spondylolysis. 
&nbsp;

<ol start="8">
	<li>Congenital Abnormalities</li>
</ol>

Some people may be born with a congenital abnormality that affects the development of the spine, increasing the risk of spondylolysis. 
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The following measures can help prevent spondylolysis:

<ul>
	<li>Using proper technique and form when engaging in physical activities</li>
	<li>Strengthening core muscles, especially the lower back, abdomen, and hips</li>
	<li>Avoiding overusing or repeatedly performing activities that put stress on the spine</li>
	<li>Gradually increasing physical activity over time</li>
	<li>Maintaining a healthy weight</li>
	<li>Wearing appropriate footwear for physical activity</li>
	<li>Taking regular breaks during physical activity</li>
	<li>Maintaining good posture during daily activities 
	&nbsp;</li>
</ul>

A recent study aimed to assess a connection of certain spine problems with lumbar spondylolysis and spina bifida occulta (SBO)<a href="#accordion">[3]</a>. The study looked at 1190 patients who had scans of their chest, abdomen, and pelvis. The team checked how many moveable vertebrae each person had in their back and if they had a certain kind of spine joint. They then checked how many people had spondylolysis and SBO, and if there was a link between these conditions and spine problems. 
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The study found that there is a connection between spine problems and the two conditions, spondylolysis and spina bifida occulta. Understanding this relationship can help doctors better understand how spondylolysis starts, and improve its treatment. It&#39;s also important to know that people with SBO in their lower back are more likely to have a spine problem, so doctors should be careful during spinal surgery to avoid mistakes. 
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Key Points

<ul>
	<li>Spondylolysis is often caused by overuse or repetitive stress on the spine.</li>
	<li>It is most commonly seen in young athletes who participate in sports that involve repetitive bending and twisting of the spine.</li>
	<li>Symptoms of spondylolysis can include lower<a href="https://merisehat.pk/disease/chronic-back-pain"> back pain</a>, muscle spasms, and stiffness.</li>
	<li>Treatment may include rest, physical therapy, and in some cases, surgery.</li>
	<li>Prevention measures include proper technique during physical activities, strengthening core muscles, avoiding overuse, gradual increase in physical activity, maintaining a healthy weight, wearing appropriate footwear, taking regular breaks during physical activity, and maintaining good posture. 
	&nbsp;</li>
</ul>

[1] Hasler, Carol C. "Back pain during growth." PUBM, 2013:

[2] Javad Mortazavi 1, Jayran Zebardast 2, Babak Mirzashahi. "Low Back Pain in Athletes." PUBMD, 2015.

[3] Masatoshi Morimoto, Kosuke Sugiura, Kosaku Higashino, Hiroaki Manabe, Fumitake Tezuka, Keizo Wada, Kazuta Yamashita, Shoichiro Takao. "Association of spinal anomalies with spondylolysis and spina bifida occulta." springer, 2022.

[4] McDonald BT, Hanna A, Lucas JA. Spondylolysis. [Updated 2023 Jan 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.