What is spondylolysis?
Spondylolysis is a crack or stress fracture in one of the bones in your vertebrae, called the pars interarticularis. Spondylolysis is also known as a “pars defect” or “pars fracture.” The pars interarticularis is the part of the vertebrae which houses the facet joints, the bones that connect your vertebrae together. When this breaks, it causes more strain on the rest of the vertebrae. Additionally, if this continues on, it may cause your vertebrae to slip and impinge on your spinal cord, causing more severe symptoms.
Alphabet soup
Spondylolysis: pars defect or stress fracture
Spondylosis: spinal arthritis aka the ‘wear and tear’ of the spine
Spondylithesis: slippage of your vertebrae causing it to move forward or backwards
What causes spondylolysis?
Spondylolyis can be caused by repetitive trauma, such as in certain sports like football, soccer, weightlifting, or gymnastics. Prevalence of spondylolysis may be as high as 47% in certain athletes. These sports involve excessive or repetitive bending backwards and increase the risk of a pars fracture. This condition is one of the most common causes of low back pain in children and adolescents.
What symptoms can it cause?
Spondylolyisis doesn’t always cause symptoms. When it does, it usually causes only back pain that is worse with activity and bending or extending your back.
How is it diagnosed?
Dr. Webb uses a combination of your history and physical exam along with imaging to make the diagnosis. An xray of your lower back can sometimes show the fracture. If not, additional imaging may be necessary such as a MRI, CT scan, or bone scan.
What is the treatment for spondylolysis?
Treatment for spondylosis is usually centered around managing your pain and helping you return to your activities. Most patients get better with conservative/non operative treatment. This may include:
Level I – Non-operative/Conservative treatment
- Oral pain medications
- Oral steroid medications
- Physical therapy, chiropractic therapy
- Rest from sports or physical activity
- Bracing for a short time to allow the pars defect to heal
- Activity modification
Level II – Spinal Injections
- Steroid injections
- Outpatient procedures
- Done with x-ray guidance
- 1-3 injections may be needed
Level III: Surgery
- Screw fixation: If amendable, sometimes the fracture can be fixed with a titanium screw. This surgery is done through a 2-3 inch incision in the middle of the lower back. Bone graft is usually placed to support the fracture repair.
- Spinal fusion: If your vertebrae starts to slip forward because of the pars stress fracture, then a spinal fusion may be recommended. This stabilizes that segment of the spine to prevent any further slippage and impingement of the spinal nerves.