Spondylolysis

Spondylolysis is a defect or fracture of one or both wing-shaped parts of a vertebra. It most often occurs in the lower spine vertebrae, where the wing-shaped parts help keep them in place. When these wing-shaped pieces are absent or damaged, a vertebra can slide forward or backward over the bone below it, sometimes pressing on the spinal cord or a nerve root.

This slipping, known as spondylolisthesis, can cause pain in the back or buttocks and pain that radiates from the lower back down one or both legs. It may also lead to numbness or weakness in one or both legs, although sometimes it causes no symptoms.

Defects or fractures in the wing-shaped parts of vertebrae can arise from various causes. Some individuals are born with a missing or damaged wing-shaped piece. This part of a vertebra may become damaged from playing sports or engaging in strenuous activity, especially during the pre-teen and teenage years. Normal age-related changes can weaken this part of a vertebra and result in fractures or other damage.

Spondylolysis is categorized into the following five types depending on the source of the condition:

• Degenerative: results from congenital abnormalities
• Dysplastic: caused by degenerative changes in the intervertebral discs
• Isthmic: injury- and fracture-related, the most common type of spondylolysis, often affecting adolescents and young adults
• Pathologic: results from bone diseases, infections and tumors
• Traumatic: caused by acute fractures in the neural arch

The causes of spondylolysis can vary, but they usually involve repeated stress on the spine due to activities such as weightlifting, gymnastics and contact sports. Some cases are congenital due to a weak or thin pars interarticularis.

Higher-risk groups for spondylolysis include individuals with specific genetic predispositions or conditions, those who engage in certain sports and those who experience repetitive stress on the lower back. Individuals born with spina bifida occulta or excessive lumbar lordosis have a higher likelihood of developing spondylolysis. High-contact sports that require backward bending or twisting, such as gymnastics, football and weightlifting, elevate the risk of repetitive hyperextension and rotation, which in turn contributes to spondylolysis. Additional risk factors include trauma, excess weight and advancing age.

Proper precautions, such as warm-ups and stretching exercises, are crucial before engaging in strenuous physical activity, particularly for young athletes who are still growing and developing the muscles that support the joints and bones. It is also essential to use proper technique and equipment, maintain a good posture while sitting or standing and rest following strenuous activities. Should persistent back pain develop due to a specific activity, your doctor may recommend modification, bracing or physical therapy.

Symptoms of spondylolysis include pain that can range from mild to severe and is localized in the lower back area. The pain worsens with activities such as bending forward or twisting the spine. Stiffness in the lower back region is also common and can increase with activity. Other possible symptoms include muscle spasms, tingling or numbness in the legs and difficulty standing up straight.

Spondylolysis is diagnosed through physical examination, X-rays, computed tomography (CT) scans or magnetic resonance imaging (MRI). During these tests, the doctor will look for spinal deformities or changes, such as fractures. Additionally, the doctor may ask questions about your medical history and activities to help confirm a diagnosis of spondylolysis.

Treatment for spondylolysis begins with stopping any physical activity that may have caused damage to the vertebrae or worsens pain. For pain relief, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. Physical therapy may help strengthen the core muscles of the abdomen and back. If necessary, losing weight may also assist in alleviating symptoms. In cases of severe pain or persistent vertebral movement, surgery may sometimes be indicated.

The experts at the Montefiore Einstein Department of Physical Medicine and Rehabilitation will work with you and your physicians to develop an individualized prevention and recovery plan that includes physical and occupational therapy, non-opioid-based pain management and X-ray-guided local injections for pain control.

Living with spondylolysis generally involves pain management and avoiding activities that might further stress the spine. With rest, activity modification, bracing and physical therapy, symptoms often improve. Many also find relief through lifestyle changes, such as focusing on muscle development that supports the lower back, learning proper lifting and posture techniques and maintaining a healthy anti-inflammatory diet.