Back brace spondylolysis treatment

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Spondylolysis is a stress fracture involving the pars interarticularis of one of the vertebra in the spine.

The pars connects the vertebra in front with vertebral joints in the back. Spondylolysis occurs in the lower back. Left untreated, spondylolysis can lead to spondylolisthesis. This is a more serious condition in which one vertebra slips forward on the one below it. Both conditions can cause back pain by altering biomechanical stability in the back or by irritating nerves as they exit the spinal column.

Spondylolysis can be caused by:

• A congenital defect in the spine
• Trauma
• Chronic overextension of the back (wrestling, gymnastics)
• Degenerative conditions affecting the spine

Risk factors for spondylolysis:

• Sports:

o Gymnastics
o Football
o Diving
o Wrestling
o Weightlifting

• Improper exercise technique

Symptoms of spondylolysis:

• Low back pain
• Spasms in the back and hamstring muscles
• Pain radiating down the leg
• Back pain that starts during adolescence

Interestingly, many patients with spondylolysis have no symptoms.

History and physical exam are the first step.

Tests may include:

X-ray to look for defects and/or fractures
CT scan

Asymptomatic patients require no treatment.

Symptomatic patients should receive the following:

• Back brace to immobilize the spine for a short period (e.g. three to four months) to allow the pars defect to heal
• Analgesics and/or anti-inflammatory medication, as needed
• Stretching, beginning with gentle hamstring stretching and progressing with other stretches
• Controlled exercise with restrictions on extension of the spine

On rare occasions, spondylolysis that is not healing requires surgery to provide stability and to reduce pressure on the nerves.

• Occasionally, a decompressive laminectomy may be needed to reduce pressure on the nerves. Unfortuantely, done alone, this procedure may increase spinal instability.
• A spinal fusion may be needed to provide stabilization of the spine.

If both a decompressive laminectomy and spinal fusion are needed, then both procedures are done at the same time.

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