Lumbosacral spondylolysis

Search Strategy

I've been searching on pubmed and web of knowledge. Always with the words lumbosacral spondylolysis. I also searched on google scholar, with the same searchwords. I’ve tried to base on the most quantified articles.


Definition/Description

Lumbar spondylolysis is an anatomic defect in the pars interarticularis or isthmus. It is usually asymptomatic. However, it may cause low back pain or sciatica secondary to muscle or ligament strain, spinal or foraminal stenosis, facet degeneration or related disk degeneration, and herniation. It is considered to be formed secondary to repetitive stress or trauma. Although it has been reported that genetic factors are important in the development of isthmic spondylolisthesis, predisposing anatomic factors in the formation of spondylolysis have not been clearly revealed yet.
Lumbosacral spondylolysis is most common at L5, accounting for 85% of all cases, and may be observed as high as L2.Therefore, a slip is most common at the level of L5 slipping forward on S1. Lumbosacral spondylolysis is the cause of the most common type of spondylolisthesis.


Epidemiology /Etiology

Numerous hypotheses have been proposed on the etiology of lumbosacral spondylolysis, as follows:
• Separate ossification centers
• Fracture during postnatal life
• Stress fracture
• Increased lumbar lordosis
• Impingement of the articular process on the pars articularis
• Weakness of supporting structures
• Growth
• Pathologic changes in the pars articularis
• Dysplasia of the pars interarticularis
However, mechanical factors are widely believed to be the cause or at least the trigger of the development of lumbosacral spondylolysis, especially when congenital abnormalities are present.
When the defect in the pars interarticularis is not associated with a forward displacement, the term spondylolysis applies. The term spondylolisthesis is derived from spondylos and listhesis, meaning movement or slipping, and refers to the slipping forward of one vertebra on the next caudal vertebra.


Diagnostic Procedures

You can diagnose spondylolysis by checking your posture and the amount of movement in your low back. Checking which movements cause pain etc. Often X-rays are ordered, so the doctor can see which verterbra is slipping.

Physical Therapy Management

Most of the time there is a non-surgical treatment started. This treatment may include rest, anti-inflammatory medication to reduce the swelling, drugs to reduce pain, a brace for stabilization and physical therapy. This physical therapy is needed to improve your strength and flexibility. In the therapy your patient need to do ADL, so he can move on with his normal life without pain. First, the exercises you learn, may be gentle stretches or posture changes to reduce pain. Afterwards more aerobic exercises are recommend, for example cycling, swimming.
If the doctor diagnoses an acute pars fracture that has the potential to heal, it may be recommended that you wear a rigid back brace for two to three months. This usually occurs in children and teenagers who begin having back pain and see their doctor early on.

Resources


emedicine. (2011, 05 06). Opgehaald van lumbosacral spondylolysis: http://emedicine.medscape.com/article/95691-overview#a0101
Group, M. M. (2011). A Patient's Guide to Lumbar Spondylolisthesis. Opgehaald van Orthopod: http://www.eorthopod.com/content/lumbar-spondylolisthesis
spondylolisthesis, A. i. (2010). North american spine society .
Wilkins, L. W. (2011). Evaluation of the Relationship Between L5-S1 Spondylolysis and Isthmic Spondylolisthesis and Lumbosacral-Pelvic Morphology by Imaging via 2- and 3-Dimensional Reformatted Computed Tomography. Journal of Computer Assisted Tomography , 9-15.