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.
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Information, in part, from the American Academy of Orthopedic Surgeons
Spondylolysis occurs when there is a stress fracture involving the pars interarticularis of the vertebrae of the spine.
The pars connects the vertebral body in front with the vertebral joints behind. This condition most often 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 biomechanics in the back or by pinching a nerve as it leaves the spinal column.
Spondylolysis can be caused by:
• A congenital defect in the spine, which usually appears a few years after birth
• Acute trauma to the back
• Chronic overextension of the back from sports and other activities
• Degenerative conditions of the spine
There are risk factors for spondylolysis.
• Sports such as:
o Football, especially the offensive line
• Improper training technique
Symptoms may include:
• Pain across the lower back
• Spasms in the back and hamstring muscles
• Pain radiating down the leg
• Back pain that starts during adolescence
However, many people with spondylolysis have no symptoms at all.
The doctor will ask about symptoms and medical history, and perform a physical exam.
Tests may include:
If a patient does not have symptoms from the spondylolysis, no treatment is needed.
If the patient has symptoms, the recommended treatment program for active spondylolysis is usually a combination of the following:
• Back brace to immobilize the spine for a short period (e.g. four months) to allow the pars defect to heal
• Pain medications and/or anti-inflammatory medication, as needed
• Stretching, beginning with gentle hamstring stretching and progressing with additional stretches over time
• Exercise that is controlled and builds gradually over time, with restrictions on extension (bending backwards)
On rare occasions, spondylolysis that is not healing or has neurological components can require surgery to provide internal fixation and stability to the area, and if necessary to reduce pressure on the nerves.
• Occasionally, a decompressive laminectomy may be needed to reduce pressure on the nerves in the area. Unfortunately, this procedure increases spinal instability.
• A spinal fusion may be needed to provide stabilization of the affected area of the spine.
To reduce the risk of getting spondylolysis:
• Limit participation in certain sports
• Keep the abdominal and back muscles strong and the hamstring muscles stretched
• Warm up properly before exercising.
• Learn proper techniques for exercise and athletic activities.
• Seek early medical care for chronic back pain. Early vertebral stress fractures, particularly in adolescents and young adults, may heal with rest.
Get more information about spondylolysis treatment and related topics as well as...
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