Spondylolisis

definition

Caused by a defect in the pars interarticularis without any displacement.

Degeneration of vertebra, affecting intervertebral discs

Indicates a fusion of vertebrae and immobilisation.

Can cause spondylolisthesis.

Definition ( Continued)

Pars interarticularis=between lamina & inferior facet underneath the pedicle and superior facet above; joins adjacent facet joints of the spine.

Patho-physiology

Narrowing of vertebral column and area between pars articularis.

Defect in continuity of vertebral bodies

Bridged by fibrous tissue Potential mechanical instability Mechanical stress to the neural

arch Osseous defect bridged by

connective tissue and cartilage Exert pressure on nerve root.

Patho-physiology (Continued)

Repetitive mechanical stress- hyperextension & trunk rotation

Mostly fatigue #’s→ repetitive stress & load

Greatest load with flex/ext movement at L5/S1

↓ acute pars #’s in older people→ ↑ in neural arch strength (4th-5th decade)

Causes & risk factors

Congenital defect Genetic predisposition Direct trauma to the isthmus with

non-adhesion Indirect trauma with a stress

fracture Possible weakness in pars

interarticularis Condition: asymptomatic or slight

to severe pain in lower back ↑ incidence in athletes- gymnasts &

football.

Causes & risk factors ( Continued) Incidence varies according to

ethnicity, sex, sports activity, family history, occupation & relevant diseases.

Relevant diseases= spina bifida occulta, osteoporosis, osteogenesis imperfecta, cerebral palsy, Scheuermann’s disease & scoliosis.

Repetitive mechanical stress.

Causes & risk factors ( Continued) Athletes at Risk

(Sport): Gymnasts Divers Offensive linemen in

football Pole vaulters Weight lifters Wrestlers Dancers High jumpers

Signs and symptoms

Incidence: 6% of general population

Common in adolescents

Present without any obvious symptoms

Pain with hyperextension Pain increases- starts with sport,

present in ADL’s and eventually interferes with sleep.

Hyperlordotic lower back Tightness of hamstring mm.

Signs and symptoms (continued)

Aching lower back, usually unilateral which localises around belt area.

May feel like a m. strain Back stiffness No nerve root pain Symptoms eased by rest

Special tests

Standing one-legged hyperextension test:

Stand on the leg of the same side on which there is pain (i.e., if the pain is on the right side, stand on your right leg). Then, gently lean backwards. If the pain is reproduced, this may be a positive sign for spondylolysis.

Diagnosis

The doctor will perform a physical exam.

Diagnosis is also based upon clinical history

An X-ray of the lower back can show any fractured vertebra.

CT scan or MRI to detect very small fractures.

Medical management

Early diagnosis is important

Rest Mobilise joints for pain relief:

PA grade 2 for pain Lumbar rotations grade 4- for

pain Relieve muscle spasm Strengthen postural muscles –

lumbar & abdominal stabilisers Mobilise lumbar fascia

Medical management ( Continued)

Muscle stretches – short spinal mm.,hamstrings Home advice regarding sport → be cautious Corset – Boston brace Trigger points Massage Cross training that is done pain-free Anti-inflammatory medication Electrical stimulation – heal bone

Surgery: Spinal fusion between lumbar vertebra & sacrum

Preventions of  Spondylolysis Injury

Support lower back b.m.o maintaining abdominal & back stabilisers

Do activities that do not place stress on the lower back

Avoid over-exercising Maintain a good posture Kinetic handling Good back support – sit for long

periods

X-rays

“Scotty-dog” Ears shaped by superior facet Face by transverse process Eye is one pedicle Legs shaped by inferior facet Body shaped by lamina Tail and hind legs by opposite facet With defect, collar around neck.

X-ray

X-ray

Article

Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain

Article

Objective: To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back pain.

Aim: establish the prevalence of lumbar spondylolysis in the general adult population and to evaluate whether there was a significant correlation between age and prevalence.

Few studies have demonstrated the significance/ prevalence of spondylolysis in adults.

Article

Population: adults older than 20 years; went for an abdominal or pelvis CT scan. Exclude patients that had a CT scan for low back pain. Separated into age into different decades. 2 555 evaluated, 203 positive cases 8% prevalence.

Where: United States, July 2008- November 2008.

Made us of Multi-detector Computed Tomography(MDCT)

Images reviewed by radiologists.

Article

Conclusion: No significant ↑ in prevalence in patients older than 20

years. Symptomatic lumbar pars defects do not occur in this

population Treatable cause of low back pain. Study failed to support hypothesis that lumbar

spondylolysis ↑ with age. Male:female 1,5:1.

References

Barnes,R.2011.NEUROMUSCULAR-SKELETAL REHABILITATION DICTATE.(Unpublished dictate.) University of the Free State , Free State.

Asher, A. 2008. Spondylolysis. (http://backandneck.about.com/od/conditions/p/Spondylosis.htm)

Retrieved on 1 September 2012.

Plone Foundation. 2007. Physical Therapy Corner: Spondylolisthesis and Spondylolysis in Gymnasts. (http://www.nismat.org/ptcor/spondylo)

Retrieved on 3 September 2012.

Where In City. 2011. Spondylolysis Injury. (http://www.whereincity.com/medical/topic/back-and-neck/diseases/spondylolysis-injury-102.htm)

Retrieved on 3 September 2012.

Standaert, CJ and Herring, SA. 2000. Spondylolysis: a critical review. British Journal of Sports Medicine 34:415-422.

References

Cluett, J. 2011. Spondylolysis. (http://orthopedics.about.com/cs/spondylosis/g/spondylolysis.htm)

Retrieved on 1 September 2012.

Asher,A. 2005. Spondylolysis Definition. (http://backandneck.about.com/od/s/g/spondylosis.htm)

Retrieved on 1 September 2012.

Spine-health.com. 2012. Spondylolysis Definition. (http://www.spine-health.com/glossary/s/spondylolysis)

Retrieved on 3 September 2012.

Brooks KB, Southam SL, Mlady GW, Logan J and Rosett M. 2009. Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain. Skeletal Radiology (2010) 39:669-673.