Spondylolysis relates to instability of specific bones
in the low back. It a very common cause of back pain, particularly in
adolescents. Gymnasts who perform routines that bend and arch the back
are often victims of spondylolysis or spondylolisthesis.
Spondylolisthesis and spondylolysis are caused by joint instability in
the low back. The rear part of spinal vertebrae has facet joints that
act as hinges, allowing our spines to twist and bend. Sometimes, however,
the posterior element can crack. Either from heredity or wear and tear,
part of the posterior element called the pars interarticularis can crack,
causing the vertebrae to slip forward out of its correct position. Spondylolysis
occurs when the PARS hinge is cracked, but the vertebrae is still in its
correct position. Spondylolisthesis occurs when the cracked PARS has allowed
the vertebrae to slide forward out of its correct position. If left untreated,
spondylolysis can lead to spondylolisthesis.
Interestingly, in many cases, spondylolisthesis may have no symptoms,
so most people may not know they have it. Back pain is the most common
symptom, particularly in the lower back. This back pain may be mistaken
for a muscle strain. Muscle spasms that occur as a result of spondylolysis
may cause an overall feeling of stiffness in the back and may effect posture.
Outlined below are some of the diagnostic tools that your physician may
use to gain insight into your condition and determine the best treatment
plan for your condition.
- Medical history: Conducting a detailed medical history
helps the doctor better understand the possible causes of your back
and neck pain which can help outline the most appropriate treatment.
- Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
- X-rays are usually the first step in diagnostic testing
methods. X-rays show bones and the space between bones. They are of
limited value, however, since they do not show muscles and ligaments.
- MRI (magnetic resonance imaging) uses a magnetic field
and radio waves to generate highly detailed pictures of the inside of
your body. Since X-rays only show bones, MRIs are needed to visualize
soft tissues like discs in the spine. This type of imaging is very safe
and usually pain-free.
- CT scan/myelogram: A CT scan is similar to an MRI in
that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves. A local
anesthetic is injected into the low back to numb the area. A lumbar
puncture (spinal tap) is then performed. A dye is injected into the
spinal canal to reveal where problems lie.
- Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup. These
tests, called electromyography (EMG) or somato sensory evoked potentials
(SSEP), assist your doctor in understanding how your nerves or spinal
cord are affected by your condition.
- Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton. Bone
scans are also used for finding lesions for biopsy or excision.
- Discography is used to determine the internal structure
of a disc. It is performed by using a local anesthetic and injecting
a dye into the disc under X-ray guidance. An X-ray and CT scan are performed
to view the disc composition to determine if its structure is normal
or abnormal. In addition to the disc appearance, your doctor will note
any pain associated with this injection. The benefit of a discogram
is that it enables the physician to confirm the disc level that is causing
your pain. This ensures that surgery will be more successful and reduces
the risk of operating on the wrong disc.
- Injections: Pain-relieving injections can relieve back
pain and give the physician important information about your problem,
as well as provide a bridge therapy.
Conservative treatments should always be considered first when treating
spondylolysis. Nonsurgical treatment methods include resting and refraining
from usual activities, taking anti-inflammatory medication, and incorporating
a stretching and strengthening program. While ligaments and muscles can
help hold the vertebrae in place, over time, surgery may be necessary
to install surgical instrumentation or bone grafts that lock the vertebra
in place so that it does not slide out of position and damage the spinal
nerves. Surgery may involve a fusion and/or screws and rods.
How do I know if I am at risk for spondylolysis?
Those with a family history of spondylolysis or weak vertebrae are more
susceptible to developing the condition. Also, athletes involved in activities
that place a great deal of stress on the back, such as football players
and weight lifters, are at greater risk for fracturing the vertebrae,