Introduction

Adolescents that participate in high impact sports and adults with physically demanding jobs have the greatest risk of spondylolysis, a type of stress fracture in the lower part of the spine.  Spondylolysis may or may not cause symptoms, such as low back pain.  Fortunately, the majority of people with spondylolysis are successfully treated with rest, pain management, and physical therapy.

Anatomy

Your spine is composed of a series of bones called vertebrae.  The lumbar spine forms the curve below your waist in your lower back.  Five large vertebrae make up the lumbar spine.  A boney arch at the back of the vertebra, called the pars (pars interarticularis), and the facet joints connect the lumbar vertebrae together.

An opening in the center of each vertebra forms the spinal canal.  Your spinal cord is located inside the protective spinal canal.  Nerves that extend off of the spinal cord travel throughout your body and exchange information with your brain.

Causes

Spondylolysis is a stress fracture in the pars of the vertebrae in the lumbar spine.  Stress fractures are tiny hairline breaks in the bone.  Stress fractures result from high impact force, back hyperextension, or repetitive stress.

Symptoms

Spondylolysis may or may not cause symptoms.  Spondylolysis can cause pain that extends throughout the lower back.  It may feel as if you have a muscle sprain.

Diagnosis

Your doctor can diagnose spondylolysis by reviewing your medical history and examining your back.  You should tell your doctor about sports participation, physical training, or job duties that may have contributed to a stress fracture in your lumbar spine.

Imaging tests are used to identify a stress fracture.  An X-ray creates a picture of the vertebrae to confirm the fracture and vertebral alignment.  Computed tomography (CT) scans, single emission computed tomography (SPECT) scans, magnetic resonance imaging (MRI) scans, or bone scans provide even more detailed images.

Treatment

For the majority of people, spondylolysis is treated with non-surgical methods aimed at healing the pars, and pain management.  Your doctor will restrict your activity level at first.  You may need to wear a back brace for about 4 months to allow the pars to heal.  Anti-inflammatory and pain medication can help ease your discomfort.

You may be referred to physical therapy to learn exercises to stretch your hamstrings and strengthen your back and abdominal muscles.  Your doctor will increase your activity level gradually.  In most cases, people can return to their former activities.

Am I At Risk

• Spondylolysis can occur in adolescents from stress on the lower back during high impact sports, such as gymnastics, weight lifting, football, or high jumping in track.
• Spondylolysis can occur in adults that participate in physically demanding jobs, high impact sports, or intense physical training.
• Some people are born with thin vertebral bones that are susceptible to spondylolysis.

Complications

Non-surgical pain management treatments for spondylolysis cannot correct structural abnormalities in the spine.  In rare cases, the vertebrae may move out of position, a condition called spondylolisthesis.  In the rare case of spondylolisthesis, spinal fusion surgery is used to secure the bones together.