Spondylolysis is a stress fracture of vertebra that may progress into spondylolisthesis, a condition of displacement of vertebrae from the spinal column. Spondylolysis is the cause for frequent low back pain in children. It is more common among children and teenagers who participate actively in sports such as football, weightlifting and gymnastics.
Spondylolysis occurs as a result of a defect or stress fracture in the pars interarticularis, the part of the lumbar spine joining the upper and lower joints. Genetic factors may have a role. Children born with thin vertebra are prone to vertebral stress fractures. Also, repetitive trauma to the lower back area that occurs during sports and other activities can cause weakness of the pars interarticularis, resulting in spondylolysis.
Although initially the patient may not have any symptoms, lower back pain is apparent during the teenage growth spurt period. The pain worsens with vigorous physical activities and exercises. At times, the pain may feel similar to a muscle strain.
Risk factors for developing spondylolysis include:
Untreated spondylolysis may lead to further complications including:
Your surgeon diagnoses spondylolysis by asking several questions and performing several tests that includes:
Primary treatment for spondylolysis is always conservative. The goal of the conservative treatment is to reduce the pain, allow the fracture to heal and improve the function.
Conservative treatment options include:
Surgery is usually required if spondylolysis progressed into spondylolisthesis. The goal of the surgery is to remove any abnormal bone compressing a nerve and to stabilize the spine.
Decompressive Laminectomy & Spinal Fusion: In this procedure a portion of the bone or lamina imparting pressure on the nerves is removed. A surgical incision is made in the back, then part of the bone and thickened tissue pressing on the spinal nerves is removed. This allows more space for the nerves thus relieving pain and pressure. This procedure makes the spine unstable and therefore spinal fusion will be performed to stabilize the spine.
Spinal fusion is the procedure of joining two adjacent vertebrae. During the procedure a piece of bone, taken from elsewhere in the body or donated from a bone bank, is transplanted between the adjacent vertebrae. As healing occurs, the transplanted bone fuses with the spine. This stimulates growth of a solid mass of bone which helps to stabilize the spine. In some cases, metal implants such as rods, hooks, wires, plates or screws are used to hold the vertebra firm until the new bone grows between them.
Although spondylolysis is not completely preventable, certain factors can reduce the risk of developing the condition:
Diagnosis includes medical history coupled with physical and neurological examination. Neurological examination is done to indicate any neurological injury and involves evaluation of reflexes and muscle weakness by various tests. To confirm the diagnosis the doctor may order a MRI to evaluate changes in the disc and spinal nerves.
Non-surgical treatment is preferred over surgery and includes rest, activity modification, and pain medication which includes non-steroidal anti-inflammatory drugs, muscle relaxants and epidural analgesic injections. Back braces are recommended for a few days to keep the lower back still and reduce mechanical pain due to movement. Physical therapy or acupuncture may be helpful in some cases.
Surgery is considered in cases with significant leg pain, muscle weakness and numbness that is unresolved after conservative treatment measures. Urgent surgery may be required if neurologic dysfunction or cauda equine syndrome occurs.
Microdiscetomy is the most commonly used surgical procedure for lumbar disc herniation. It involves removal of part of the herniated disc causing nerve compression. It is a comparatively safe procedure but some of the risks include infection, nerve damage, dural leak, or hematoma. Most patients undergoing surgery find significant respite in pain after the surgery.
Talk to your surgeon about any concerns you have about surgery.: