Spondylolysis
Original Editors
Lead Editors - Andrea Nees - Elien Vanderlinden - Heleen Van Cleynenbreugel - Els Van haver
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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 or isthmus of the vertebra. The term derives from the Greek words spondylos (vertebra) and lysis (defect). [1][2] It can cause a slipping of the vertebra, 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. It is the pars interarticularis that is affected in spondylolysis.
Epidemiology /Etiology[edit | edit source]
Spondylolysis affects 3-6% of the population. [1][2][3] This condition appears in the first or second decade of life, the frequency of spondylolysis increases with age until 20 years. [4][5] There is however no change in prevalence with increasing age from 20 to 80 years old. Men are affected two times more as women. [2][6] There is a possible genetic tendency for people with lower cortical bone density at the pars interarticularis. [2][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 distribution at the pars interarticularis is the highest in extension and rotation movements. [1][2][3] Spondylolysis occurs mostly at L5 (80-95%) due to repetitve hyperextension. [2][5][3] The caudal edge of the inferior articular facet of L4 has an increased contact then with the pars interarticularis of L5.
Characteristics/Clinical Presentation[edit | edit source]
In most cases, spondylolysis is asymptomatic. If there are any symptoms, they often have following characteristics:
- Onset of pain is gradual or acute (after intense athletic activity) [8][9][1]
- There can be a recent or old history of local trauma [8]
- Intense pain confines ADL-activities [8][1]
- Symptons aggrevate after a stressful event [8]
- Rest usually relieves the symptoms [1]
Specific symptons depend on the region of the spine that is affected. Lumbar spondylolysis whil show other symptons than thoracic or cervical spondylolysis.
Symptons for lumbar spondylolysis are:
- Focal low back pain with radiation into the buttock or proximal lower limb [8][9][1]
- Symptoms can increase when a movement like lumbar spinal extension or rotation is accomplished [9][1]
- Children under 13 years old show tenderness or pain on extension [10]
- Children can present a postural deformity or abnormal gait pattern [1]
- Pain through the full range of lumbar motion [11]
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
Diagnostic Procedures[edit | edit source]
The golden standard for the diagnosis of spondylolysis is the combination of SPECT and computed tomography (CT). When a pars fracture is present, computed tomography can clearly visualize the spondylolysis. On axial CT scans, the neural arch should be closed and continuous at the level of the pedicles. When there is a pars defect, there is a discontinuity at this level. Sagittal CT images differ better between a pars defect and the facet joint and are also the most accurate in showing incomplete fractures. MRI shows promising results in detecting spondylolysis but can also be used to determine the state of the disc above and below the affected vertebra.
Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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Clinical Bottom Line[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 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)
- ↑ 8.0 8.1 8.2 8.3 8.4 Syrmou E., Tsitsopoulos P.P., Marinopoulos D., Tsnodis C., Anagnostopoulos I. Spondylolysis: A review and reappraisal. Hippokratia 2010,14,1,1:17-21 (Level of evidence: A2)
- ↑ 9.0 9.1 9.2 Standaert C.J., Herring S.A. Spondylolysis: a critical review. Br J Sports Med 2000;34:415–422. (Level of evidence: A2)
- ↑ Tetsuki M, Takaaki I, Shinsuke K, Ryoji M. Lumbar spondylolysis in children and adolescents. J Bone Joint Surg [Br] l995;77-B:620-5 (Level of evidence: B1)
- ↑ Freeman B. J. C. and Debnath U. K. The management of Spondylolysis and Spondylolisthesis. Surgery for Low Back Pain. 2010:4:137-145. (Level of evidence: A2)
