Spondylolysis
occurs as a result of a defect with resulting stress fractures of the pars
interarticularis of the vertebra (1, 2, 3, 4, 5). It is found commonly at L5
and can occur not only unilaterally but bilaterally as well (2, 3). Over
time it may progress to a spondylolisthesis (slipping of a vertebra on the
vertebra below) (3, 4, 5). Spondylolysis affects about three to seven
percent of Americans (1). It is considered an overuse injury and is a cause
of low back pain found in young children and teens involved in sports which
requires frequent extension and rotation of the spine ie. gymnastics, dance,
baseball pitching, tennis, volleyball, football, weight lifting, etc. (1, 2,
3, 4, 5). Predisposing factors for spondylolysis includes: hyperlordosis,
thoracic kyphosis, iliopsoas inflexibility, thoracolumbar facial tightness,
abdominal weakness, female athlete triad (2).
Symptoms of Spondylolysis
Individuals with spondylolysis can sometimes by asymptomatic but often
presents as focal low back pain which may be tender upon palpation over the
site of the fracture (1, 4). Pain is usually made worse with vigorous
activities and with activities which requires back extension (1, 2, 3, 4).
Pain may also be reproduced by having the patient stand on one leg and
hyperextending the lumbar spine (unilateral extension test or Micheli’s
test) (4). The patient then repeats the move on the other side. If the test
produces pain, this is indicative of active spondylolysis (4).
Diagnosis of Spondylolysis
Making an early diagnosis with a pars defect is important to help assess
early stage pars defects that that are healing and resulting in bone
re-union (5). Medical imaging can be utilized to help diagnosis
spondylolysis. A radiograph can be performed but has low sensitivity (2). A
single photon emission computed tomography (SPECT) scan can also be
performed to allow for improved visibility but a positive SPECT needs to be
followed up with a CT scan secondary to low specificity of a SPECT (2). A CT
can help with identifying anatomical details of a pars defect but is not
good at identifying an active vs. inactive fracture or early stress reaction
(2). A combination of SPECT and CT can produce more detailed results (2). A
SPECT allows for high sensitivity for bone activity, while CT allows for the
highest anatomical specificity (2). A negative CT and a positive SPECT
suggests a stress response, pre-lysis, early incomplete and good prognosis
for healing and bone union (2). A positive CT and negative SPECT suggests a
non union chronic lesion (2). A MRI is another imaging tool that can be
utilized which is sensitive for early active lesions and visualization of
other spinal disorders (2). However, it has lower sensitivity involving
incomplete fractures and lacks ability to grade the lesion & detect bony
healing (2).
Spondylosis can be subdivided in five categories: dysplastic, isthmic,
degenerative, traumatic and pathological - each representing distinct
considerations and characteristics for all healthcare providers (5):
|
Type of Spondylolysis |
Title |
Pathogenesis |
| Type I |
Dysplastic |
Congenital Abnormalities |
| Type II |
Isthmic |
Stress fractures in the pars
interarticularis |
| Type III |
Degenerative |
Degeneration of the
intervertebral discs |
| Type IV |
Traumatic |
Acute fractures in areas other
than the pars |
| Type V |
Pathological |
Bone diseases, tumors, or
infections |
Spondylolysis Treatment Options for a PT (1, 2, 3, 4, 5)
• Rest, Removal From Sport
• Bracing
• Postural/Functional Training
• Stretching
• Strengthening/Core Stabilization
• Manual Therapy
