Spondylolysis: Difference between revisions
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== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
In most cases, spondylolysis is asymptomatic. If there are any symptoms, they often meet following characteristics:<br> | |||
*Onset of pain is gradual or acute (after intense athletic activity) | |||
*There can be a recent or old history of local trauma | |||
*Intense pain confines ADL-activities | |||
*Symptons aggreavte after a stressful event | |||
*Rest usually relieves the symptoms | |||
== Differential Diagnosis == | == Differential Diagnosis == |
Revision as of 12:47, 23 May 2012
Original Editors
Lead Editors - Andrea Nees - Elien Vanderlinden - Heleen Van Cleynenbreugel - Els Van haver
Search Strategy[edit | edit source]
Search engines PubMed, Web of Knowledge, Pedro
Keywords Spondylolysis + Physiotherapy / Physical Therapy / Anatomy / Medical management / Diagnosis
Searches have been performed between 28/03/2012 and 20/05/2012
Definition/Description[edit | edit source]
Spondylolysis is a unilateral or bilateral bony defect in the pars interarticularis of the vertebra. The term derives from the Greek words spondylos (vertebra) and lysis (defect). [1][2] It can cause a slipping of the vertebrae, in which case the term spondylolytic spondylolysthesis is used.
Clinically Relevant Anatomy[edit | edit source]
Vertebrae consist of the vertebral body and a bony ring or arcus which protects the spinal cord. The arcus is formed by 2 pedicles which attach to the dorsal side of the vertebral body and 2 laminae, which complete the arch. The area between the pedicle and the lamina is called the pars interarticularis and is in fact the weakest part of the arcus.
Epidemiology /Etiology[edit | edit source]
Spondylolysis affects 3-6% of the population.[1][2][3] This condition appears in the first or second decades of life, the frequency of spondylolysis increases with age until 20 years.[4][5] There is no change in prevalence with increasing age from 20 to 80 years old. Men are affected two times more as women.[2][6]
Spondylolysis occurs mostly at L5 (80-95%).[2][5][3] There is increased prevalence in specific ethnic, sports and family groups.[7] The young athletic population has a spondylolysis more frequently. There is an increased risk in gymnasts, football players, cricketers, swimmers, divers, weight lifters and wrestlers.[2][3]
Spondylolysis is considered to be a stress fracture that results from mechanical stress at the pars interarticularis. These stress fractures occur due to repetitive load and stress, rather than being caused by a single traumatic event.[2][3] The stress distributions at the pars interarticularis are the highest in extension and rotation movements.[1][2][3] There is a possible genetic tendency for people with lower cortical bone density at the pars interarticularis.[2][3]
Characteristics/Clinical Presentation[edit | edit source]
In most cases, spondylolysis is asymptomatic. If there are any symptoms, they often meet following characteristics:
- Onset of pain is gradual or acute (after intense athletic activity)
- There can be a recent or old history of local trauma
- Intense pain confines ADL-activities
- Symptons aggreavte after a stressful event
- Rest usually relieves the symptoms
Differential Diagnosis[edit | edit source]
- Disc Injuries: Disc Herniation
- Lumbosacral Discogenic Pain Syndrome
- Facet Joint Syndrome
- Acute Bony Injuries
- Sprain/Strain Injuries
- Spondylolisthesis
- Myofascial Pain in Athletes
- Sacroiliac Joint Injury
- Lumbar radiculopathy
- Osteoid osteoma
- Osteomyelitis
- Spinal stenosis
- Stress fracture
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Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
References[edit | edit source]
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- ↑ 1.0 1.1 1.2 Gunzburg R., Szpalski M., Spondylolysis, Spondylolisthesis and Degenerative Spondylolisthesis, Lippincott Williams and Wilkins, 2006, p. 21. (Level of evidence: D)
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 MacAuley D., Best T., Evidence-based Sports Medicine, Blackwell Publishing, 2007, p. 282. (Level of evidence: D)
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Haun D.W., Kettner N.W., Spondylolysis and spondylolisthesis: a narrative review of etiology, diagnosis, and conservative management, J Chiropr Med 2005;4:206–217 (Level of evidence: A1)
- ↑ Aufderheide A.C., Rodriguez-Martin C., The Cambridge Encyclopedia Of Human Paleopathology, Cambridge University Press, 1998, p. 63. (Level of evidence: D
- ↑ 5.0 5.1 Fast A., Goldsher D., Navigating The Adult Spine, Demos Medical Publishing, 2007, p. 55. (Level of evidence: D)
- ↑ Depalma M.J., iSpine: Evidence-based interventional spine care, Demos Medical Publishing, 2011, p. 156-157. (Level of evidence: D)
- ↑ Ruiz-Cotorro A., Spondylolysis in young tennis players, Br J Sports Med 2006;40:441–446 (Level of evidence: A1)