Spondylolysis is a stress fracture of the lower spinal vertebral region called the pars interarticularis. This common cause of back pain in children and adolescents often heals well with conservative treatment. However, it can potentially progress to spondylolisthesis if the fracture leads to vertebral slippage. This article provides an in-depth overview of what causes spondylolysis, how it is diagnosed, and both nonsurgical and surgical treatment options.

What is Spondylolysis?

Spondylolysis refers to a stress fracture of the pars interarticularis, a narrow piece of bone connecting the upper and lower facet joints. This lumbar spinal cord region is prone to stress fractures.

It most often affects the fifth lumbar vertebra (L5) but can occur at other lumbar spine levels. Lumbar spondylolysis leads to structural weakness and mobility at that spinal segment. Sometimes, it can progress to spondylolisthesis where a vertebra slips forward out of alignment.

Spondylolysis is present in up to 47% of some athlete populations. It has a prevalence of 3-7% in the general population. It is considered an overuse injury caused by repetitive stress on the lower back.

Difference Between Spondylolysis and Spondylolisthesis

Spondylolysis and spondylolisthesis are both spinal conditions that can cause lower back pain and discomfort, but they differ in important ways. The former occurs when there is a fracture in the vertebra due to stress, typically the pars interarticularis. This can be caused by repetitive stress or a congenital defect.

An illustration showing the difference between spondylolysis and spondylolisthesis as well as a normal lumbar spine region.
Photo Credit: Journal of the American Board of Family Medicine

On the other hand, when one vertebra slips forward or backward in relation to the adjacent vertebrae, it results in a condition called spondylolisthesis. Spondylolysis is a common cause as well, but it can also be caused by degenerative changes in the spine, trauma, or certain medical conditions.

Determining if your condition is spondylolysis or spondylolisthesis is an important part of your recovery process. So, make sure to give a detailed description of the discomfort you’re having to the health professional.

In both cases, patients may experience pain, stiffness, weakness, and numbness, but the specific symptoms can vary depending on the severity and location of the condition. Treatment process for cases of spondylolysis and spondylolisthesis can range from conservative measures such as pain medication, rest, and physical therapy, to more invasive interventions like spinal fusion surgery. It is crucial for individuals experiencing these symptoms to seek medical attention in order to accurately diagnose and manage their condition.

What Causes Spondylolysis and Its Risk Factors

Several factors raise the risk of developing a stress fracture in the lumbar spine:

  • Sports requiring repetitive hyperextension and rotation like gymnastics, football, weight lifting, dance, diving, volleyball
  • Genetics – Having an inherent pars defect or thin pars interarticularis is vulnerable to fracture.
  • Anatomical factors like an increased lumbosacral angle which puts more stress across the pars region
  • Being a teenage athlete – Most cases occur between ages 9 to 16 during adolescent growth spurts when bones are still maturing.
  • Male gender – It is more common in males, especially adolescent athletes. Females see a spike of stress on the low back after age 40.
  • Low bone density or osteoporosis weakens the pars and predisposes it to fracture.

Engaging in a high volume of sports requiring repeated back hyperextension significantly raises the risk especially if underlying risk factors for spondylolysis are already present.

Symptoms of Spondylolysis

A man having pain in his lower back pictured from the back
Photo Credit: D. Zinkevych, Envato Elements

Patients with spondylolysis may develop the following symptoms:

  • Localized low back pain, often described as achy or dull rather than sharp
  • Pain that worsens with extension or rotation of the lower spine, like during exercise or sports
  • Muscle spasms in the lower back, hamstrings or buttocks
  • Stiffness, tightness and tenderness in the low back
  • Pain that radiates to the buttocks or thighs in some cases
  • Back pain that comes and goes sporadically depending on activity levels

Seeking early evaluation for persistent back pain helps detect the condition before significant damage occurs. Pain that limits sports participation warrants medical assessment.

How Spondylolysis is Diagnosed

Typical steps to diagnose spondylolysis include:

  • Medical history – Age, back pain description, sports participation
  • Physical exam – Assess back mobility and pain on movement
  • Neurological exam – Check reflexes, muscle strength, and sensations
  • X-rays – Show fractures and bony defects. Oblique views best detect pars defects.
  • CT scan – Computerized Tomography provides more detailed bony imaging of the vertebrae.
  • MRI – Magnetic Resonance Imaging evaluates the health of discs and soft tissues. Can detect stress reactions early.
  • SPECT bone scanSingle-Photon Emission Computed Tomography is highly sensitive for confirming pars stress fractures.

Finding the exact site of the pars fracture dictates the appropriate treatment approach.

Nonsurgical Treatments for Spondylolysis

A pair of hands pressing on the lower back of a female patient in physical therapy as she lies on a blue mat.
Photo Credit: Elina Fairytale, Pexels

Most young athletes respond well to conservative treatment involving:

  • Activity modification – Restricting sports and avoiding hyperextension until pain resolved
  • Bracing – Custom rigid back brace or clamshell brace to stabilize the spine
  • Pain management – Anti-inflammatories and ice or heat therapy
  • Physical therapy – Flexibility, core strengthening, muscle balance training
  • Severe cases require the need to wear a back brace for 3-4 months allows the pars to heal.
  • Strict rest is avoided as maintaining muscle strength is important.
  • Full-contact competitive sports are restricted in the acute phase but light training is encouraged.

Surgery for Spondylolysis As a Treatment Option

If chronic symptomatic spondylolysis fails to improve with at least 6 months of conservative treatment, surgical options include:

  • Direct pars repair – Screws are placed across the pars defect to stabilize the fractured segment. Used for unilateral defects without slippage.
  • Pars decompression – Removing pressure on the nerves exiting the spinal canal.
  • Spinal fusion – Permanently connecting vertebrae to eliminate painful motion.

Surgery aims to relieve pain and prevent progression to spondylolisthesis. Before choosing surgery, extensive discussion of risks and benefits with the surgeon is recommended.

Spondylolysis Rehabilitation Exercises

Physical therapists instruct patients on exercises that strengthen the back without overstressing the healing pars fracture. Goals include:

  • Maintaining lumbar mobility and flexibility
  • Strengthening abdominal and core muscles to stabilize the spine
  • Building hip, gluteal and hamstring muscle strength
  • Promoting proper posture and body mechanics
  • Teaching appropriate lumber spine stabilization during movement

Low-impact aerobic conditioning maintains fitness without jarring the fracture site.

Prevention of Lumbar Spine Injuries

Strategies athletes can use to avoid developing the condition include:

  • Having excellent hamstring flexibility – Tight hamstrings increase lumbar hyperextension stress.
  • Building up training levels gradually – Sudden increases in volume or intensity raise injury risk.
  • Strengthening core muscles – Improves spine stability with movement.
  • Using proper technique when weight lifting – Avoid rounding the back.
  • Wearing a protective back brace during sports if at high genetic risk.
  • Getting adequate rest and recovery between training sessions.
  • Avoiding playing through significant back pain – Seek evaluation.

Being proactive helps reduce the chances of a spondylolysis occurring.

Long-Term Outlook for Spondylolysis

Most young athletes fully recover within 3 to 6 months with appropriate conservative treatment. However, 15-20% develop chronic symptoms lasting beyond 6 months. In these cases, surgical fusion may be required. Outcomes are generally good with rigid adherence to post-operative restrictions to allow complete healing.

An atheletic man swinging the abdominal muscles in the gym with a machine requiring him to lie face down.
Photo Credit: BoomArt, Envato Elements

If asymptomatic, most can return to sports by 8 to 12 months post-injury, gradually increasing activity under guidance. Some modification to high-risk techniques may be needed to prevent recurrence. Regular screening of at-risk athletes aims to detect spondylolysis early before it progresses to spondylolisthesis.

Frequently Asked Questions (FAQs) About Spondylolysis

Is spondylolysis a serious problem?

It can be a serious problem if not addressed, as it can lead to chronic back pain and progression to spondylolisthesis in some cases. However, with proper treatment, spondylolysis often heals well, especially in youth.

What is the cause of spondylolysis?

It is caused by repetitive stress on the pars interarticularis region of a vertebra leading to a fracture, most commonly in the low back. Sports requiring hyperextension of the spine increase risk.

Does spondylolysis go away?

It frequently heals with rest and bracing within 3-6 months in children and adolescents. In adults, it may develop into a chronic issue requiring surgery if conservative treatment fails.

What is the most common cause of spondylolysis?

The most common cause is repetitive hyperextension and stress to the lower back from sports like gymnastics, weight lifting, football, wrestling, dance, and diving during adolescent growth spurts.

How do you fix spondylolysis?

Treating this condition usually involves rest and physical therapy programs to strengthen the core, and pain relief medications. In cases where a pars fracture is present, a brace may be used to immobilize the area. Severe cases may need surgery for spondylolysis.

What is the difference between spondylolisthesis and spondylolysis?

Spondylolysis refers to a fracture or defect in the pars interarticularis of the vertebra, often due to stress or trauma. Spondylolisthesis, on the other hand, occurs when a vertebra (commonly the L5) slips forward over the one below it, which can be caused by spondylolysis.