Spondylolysis is a specific defect in the connection between vertebrae, the bones that make up the spinal column. This defect can lead to small stress fractures (breaks) in the vertebrae that can weaken the bones so much that one slips out of place, a condition called spondylolisthesis. Spondylolysis is a very common cause of low back pain.
The word spondylolysis comes from the Greek words spondylos, which means spine or vertebra, and lysis, which means a break or loosening.
Symptoms:
Many people with spondylolysis have no symptoms and don’t even know they have the condition. When symptoms do occur, low back pain is the most common. The pain usually spreads across the lower back, and might feel like a muscle strain. The pain is generally worse with vigorous exercise or activity. Symptoms often appear during the teen-age growth spurt. The typical age of a person diagnosed with spondylolysis is 15 to 16 years.
Causes:
Spondylolysis results from a weakness in a section of the vertebra called the pars interarticularis, the thin piece of bone that connects the upper and lower segments of the facet joints. Facet joints link the vertebrae directly above and below to form a working unit that permits movement of the spine.
The exact cause of the weakness of the pars interarticularis is unknown. One theory points to genetics (heredity) as a factor, suggesting that some people are born with thin vertebrae, which places them at higher risk for fractures. Another theory suggests that repetitive trauma to the lower back can weaken the pars interarticularis.
Incidence:
Spondylolysis affects about 3- 7% of Americans. The condition is a common cause of low back pain in children and the most likely cause of low back pain in people younger than 26 years of age. Spondylolysis is more common in children and teens participating in sports that place a lot of stress on the lower back or cause a constant over-stretching (hyperextending) of the spine, such as gymnastics, weightlifting, and football. It is seen more often in males than in females.
Diagnosis:
Often, a health care provider will suspect spondylolysis after an evaluation that includes a complete medical history and physical examination. An X-ray of the lower back can show any fractured vertebra and confirm the diagnosis.
A computed tomography (CT) or magnetic resonance imaging (MRI) scan might be needed to detect very small fractures. A CT or MRI scan may also be used to rule out other conditions that might be contributing to the pain, such as a herniated (bulging) disc or pinched nerve.
Treatment:
Initial treatment for spondylolysis is always conservative, and is aimed at reducing pain, permitting the fracture to heal, and returning the person to normal function. The affected person should take a break from sports and other activities until the pain subsides. An over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Motrin®), may be recommended to help reduce pain and inflammation (irritation and swelling). Stronger medications may be prescribed if the NSAIDs do not provide relief. A program of exercise and/or physical therapy will help increase pain-free movement, and improve flexibility and muscle strength.
In more severe cases of spondylolysis, a brace or back support might be used to help stabilize the lower back as the fracture heals. Epidural steroid injections, in which medication is placed directly in the space surrounding the spine, may also help reduce inflammation and ease pain.
Complications:
The pain of spondylolysis can lead to reduced mobility and inactivity. Inactivity can, in turn, result in weight gain, loss of bone density, and loss of muscle strength and flexibility in other areas of the body. In addition, spondylolysis can progress until one or more vertebrae slip out of place (spondylolisthesis).
Outlook:
Conservative treatment—rest, medication, exercise, and bracing—is often successful at relieving pain and swelling, especially when treatment is started early. About 73 percent of people have a significant reduction in pain and can return to normal activities following early treatment of spondylolysis.
Prevention:
Although spondylolysis might not be preventable, there are steps you can take to reduce the risk of fractures. Seek medical attention if you suffer a back injury or have significant low-back pain. Early treatment of spondylolysis often results in the best outcomes. Keeping your back and abdominal muscles strong can help support the lower back and prevent future stress fractures. If you have spondylolysis, it is important to choose activities and sports that do not place your lower back at risk for injury. Swimming and biking are possible options.
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Information from the National Institutes of Health, November 2008
