Spondylolysis

Spondylolysis is a type of stress fracture that develops in the vertebrae (spinal bone, see picture below). These fractures occur on the portions of the bone between the facets of the vertebra. This fracture injury occurs in the lower back in most cases. Fracture can occur on one or both sides of the vertebra. If this injury is left untreated, it can lead to more serious conditions where the injured vertebra slips forward over the vertebra sitting below it. Both conditions can cause back pain. Spondylolysis is the most common cause of back pain in adolescent athletes. Spondylolysis occurs in 4 to 6% of the young athletic population. This number is higher in young competitive athletes who repeatedly place stress on the spine during sports.

Who might be at risk for this injury?

Participation in sports that place lots of loading and torsion on the spine such as gymnastics, football (particularly offensive lineman), weight lifting, dance, soccer, rugby, diving or wrestling may place the athlete at risk for this injury. Athletes who do not perform proper athletic or exercise technique are also at risk. Also, athletes who are in an adolescent growth spurt.

How might you recognize this injury?

Individuals may report symptoms such as moderate aching pain across the lower back, spasms in the back and hamstring muscles and pain radiating partway down the leg. Some people have a peculiar gait (stiff legged, short stride gait). Interestingly, many people have no symptoms at all!

Possible Treatments

Doctors continue to debate on the best treatment protocol for spondylosis. In most cases a two day period of bed rest is recommended and appears to help with majority of individuals. Non-steroids, steroids, and anti-inflammatory medications are prescribed if bed rest does not help symptoms subside. The Children’s Hospital in Boston has found that physical therapy; electrical stimulation of the bone in the injured area, and back braces has shown promises for the treatment of spondylolysis. Rest with no sport activity from 4 to 6 weeks is recommended if a back brace is prescribed.

Limit participation in certain sports to a reasonable amount. This will help prevent overuse injury.

• Keep the abdominal and back muscles strong and the hamstring muscles flexible.
• Use proper equipment for your sport.
• Warm up properly before exercising or playing sports.
• Learn proper techniques for the specific exercise and athletic activity.
• When in doubt, seek medical care for back pain. Early vertebral stress fractures, particularly in adolescents and young adults, may heal with rest.

If rest and medications do not help ease back pain and stability, surgery may then be recommended. The surgical procedure to help cure the symptoms of spondylosis is the fusion of the vertebral bodies, that is permanently fuse or glue the vertebra together to help stabilize the spine. This has been proven to greatly improve stability in the spine and thus help treat spondylosis. Surgery is normally not recommended unless there are apparent complications.

References:

• American Academy of Orthopaedic Surgeons. Bono CM. Low-back pain in athletes. Journal of Bone & Joint Surgery - American Volume. 2004;86-A(2):382-96.
• Eddy D. Congeni J. Loud K. A review of spine injuries and return to play. Clinical Journal of Sport Medicine. 2005;15(6):453-8.
• Herman MJ. Pizzutillo PD. Spondylolysis and spondylolisthesis in the child and adolescent: a new classification. Clinical Orthopaedics & Related Research. 2005;(434):46-54.
• Peer KS, Fascione JM, Spondylolysis: a review and treatment approach. Orthopaedic Nursing. 2007;26(2):104-11.
• Micheli L, Curtis C, Stress fractures in the spine and sacrum. Clinics in Sports Medicine. 25(2006).
• Rao RD, Currier BL, Albert TJ , Bono CM, Marawar SV, Poelstra KA, and Eck JC. Degenerative Cervical Spondylosis: Clinical Syndromes, Pathogenesis, and Management
• Sonne-Holm S, Jacobsen S, Rovsing HC, Monrad H, Gebubr P. Lumbar spondylolysis: a life long dynamic condition? A cross sectional survey of 4141 adults. European Spine Journal. Nov (2006).