Spondylolysis
Denoted by a fracture in the bony ring along the spinal column, spondylolysis most commonly occurs in the lower back, which is known as the lumbar. In patients with spondylolysis, the bony formation that protects the spinal column fractures due to repeated strain. The fracture caused by spondylolysis forms in the pars interarticularis, which is the segment of back bones that conjoins the facet joints to the back of the spine. Because spondylolysis affects the pars interarticularis, the fracture is often referred to as a pars defect or pars fracture. A pars stress fracture is one of the leading causes of back pain in adolescent athletes, specifically affecting those who partake in sports in which the spine is continually bent backward.
Children and adolescents suffer most from spondylolysis because their spines are still in development, and the pars interarticularis is one of the weakest parts of an adolescent’s spine. By placing additional stress or pressure on the pars interarticularis, athletic children and adolescents are more prone to developing a pars stress fracture. Despite children being the most affected by pars defects, spondylolysis can affect athletes and people of any age.
What parts of the spine are affected by spondylolysis?
There are 24 vertebrae that comprise the human spine, with each vertebra placed on top of each other to create the spinal column. The spinal column helps to provide the basic structure to the human body and offers support to remain upright. There are 4 main portions of the spine. From top to bottom, the spine is referred to as the cervical spine, thoracic spine, lumbar spine, and sacral spine. Every vertebra of the spine encases a circular bone, which is often referred to as the body of the vertebra. A roof-like structure of bones, which include the pars interarticularis, pedicle, and lamina, create a protective hollow tube that is referred to as the spinal column. The spinal column protects the spinal cord from damage or stress.
What causes spondylolysis?
The main cause for spondylolysis is the spinal canal continually being subjected to stress or damage over time. These repetitive stresses can eventually cause a pars defect to form. One of the most common areas for a pars stress fracture to occur is the bottom-most vertebra of the spinal column, which is the vertebra that connects the spinal column to the pelvic bones. Fortunately, pars defects rarely occur in more than 1 vertebra at a time.
Initially, the affected vertebra may respond to strain by creating additional bone cells around the area affected. However, when the vertebra cannot stimulate bone material fast enough to keep up with injury, a fracture can form in the weakened portion of the bone.
While a pars defect may only affect 1 side of the pars interarticularis, it is also common that a pars fracture can affect both sides of the bone. If a stress fracture affects both sides of the pars interarticularis, the vertebra is not securely held in place by the facet joints anymore. This can cause the vertebra to move forward or backward, which is a medical condition known as spondylolisthesis.
What are the symptoms of spondylolysis?
The most common spondylolysis symptoms include stiffness, discomfort, and pain in the lower back. Bending backward may also cause pain in patients with spondylolysis. Spondylolysis symptoms may worsen with activity or alleviate with rest. In some cases, patients with spondylolysis may experience a widespread pain that moves down the lower back into the legs. This spondylolysis symptom may be caused by compression of the spinal nerves. Spinal nerves may become pinched as the body attempts to treat the symptoms of spondylolysis. As your pars defect is healed by your body, excess cartilage may form and cause a protrusion of tissue. This protrusion may grow into the nerve exit of the spine, reducing the space that the spinal nerves have. Pinching or squeezing of the spinal nerves can cause pain, discomfort, or a sense of weakness in the legs. Many patients may also experience a sensation of pins and needles along the skin where the spinal nerves travel underneath.
How can Dr. Rozbruch diagnose spondylolysis?
To diagnose spondylolysis, Dr. Rozbruch will suggest you undergo a full physical examination to assess your overall medical health. Dr. Rozbruch will ask various questions about your spondylolysis symptoms and what increases or decreases the severity of these symptoms. Dr. Rozbruch will ask what sports or activities you regularly partake in. By understanding what sports you may play, Dr. Rozbruch will be able to understand if your symptoms may be caused by spondylolysis. Dr. Rozbruch may perform a simple examination of your posture and the range of mobility you have in your lower back. Dr. Rozbruch may also perform tests to gauge your muscular strength, reflexes, or other sensations.
A spinal X-ray of your lower back may be ordered to detect and diagnose any pars defects. An oblique X-ray view allows Dr. Rozbruch to successfully diagnose a pars fracture. By tracing a line around the body of the vertebra and the bones that form the spinal canal, Dr. Rozbruch is able to see a basic outline of what appears to be the shape of a dog. When a pars defect is present, the outline of this dog shape is different and creates a darker line around the neck, which may resemble a collar on the dog’s neck. This outline is referred to as the Scotty dog sign, and the pars defect may be referred to as a Scotty dog fracture. The presence of this “collar” or dark line on the outline of the Scotty dog sign confirms a spondylolysis diagnosis.
In some cases, spinal X-rays are unable to detect smaller defects or stress fractures within the spinal bones. If Dr. Rozbruch is unable to determine if a defect or fracture is present, he may order a bone scan for additional information on your spinal health. A bone scan uses safe chemical tracers that are injected into the bloodstream, which will be easily detectable on a spinal X-ray. These chemical tracers will congregate in areas of the spine that are experiencing additional stress, which can indicate the presence of a stress fracture or pars defect.
A CT scan of the spine can also depict if the ends of a fractured bone have begun to grow together, which allows Dr. Rozbruch to understand if the pars fracture is recent or not. By determining how long a pars defect has been present, a more effective spondylolysis treatment may be able to be prescribed. In cases where additional information is still needed, a spine MRI may be ordered for a more comprehensive look at the health of your spine. A spinal MRI is an effective tool in diagnosing spondylolysis and can provide detailed information about the health of your spinal discs and soft tissues, which cannot be determined on simpler exams like an X-ray scan.
What nonsurgical spondylolysis treatments are available?
While some patients may require spondylolysis surgery, it is important to see if your spondylolysis symptoms respond to a nonsurgical spondylolysis treatment. A pars defect may heal on its own with the proper amount of rest or support. It is possible that Dr. Rozbruch may suggest resting and monitoring your symptoms to see if your pars fracture heals itself. To monitor if your spondylolysis is responding well to rest, Dr. Rozbruch may periodically order spinal X-rays. If Dr. Rozbruch suspects that your pars stress fracture is relatively recent, he may prescribe a back brace to wear for 3-4 months. By reducing spinal movement, spondylolysis symptoms such as pain or inflammation can be reduced. A back brace for spondylolysis can help the bone fracture heal itself and grow back together properly.
It is important to rest and limit strenuous activities when recovering from a spinal fracture. Adequate rest can help reduce muscle spasms and inflammation. If you have injured your spine from partaking in a sport, it is important to take a break from this activity until your spine properly heals. Patients who temporarily stop their sport and get plenty of rest usually experience a significant improvement in their spondylolysis symptoms. It is important to note that, in most cases, a patient with spondylolysis will be able to return to their sport once their spine has had time to heal properly. Physical therapy is also a spondylolysis treatment that can help alleviate the lower back pain associated with spondylolysis. Your physical therapist can also help you learn proper techniques when playing your sport to avoid future injury and reduce back pain or discomfort.
What types of spondylolysis surgeries are available?
In some cases, a nonsurgical spondylolysis treatment is not effective enough to fully treat the symptoms of spondylolysis. While the majority of patients do not require spondylolysis surgery, some individuals may need to undergo spinal surgery in order to help treat a pars defect. There are 2 main types of spondylolysis surgery, which include a laminectomy and posterior lumbar fusion.
Laminectomy
If a spinal nerve experiences pinching or pressure, this can cause moderate-to-severe pain and irritation in the lower back. If additional cartilage forms during the healing process and creates a protrusion into the spinal nerves, the nerves may be compressed uncomfortably. A laminectomy is a spinal surgery that removes the lamina bone from the spinal canal to help release the pressure placed on the spinal nerves. By reducing the stress and pressure placed on the spinal nerves, a laminectomy can help alleviate the painful symptoms associated with spinal nerve pinching.
Posterior Lumbar Fusion
A fusion of the lumbar spine may be necessary if a patient has undergone laminectomy surgery. If a vertebra has become unstable and begins to slip too far forward or backward, spine fusion surgery may be required. Lumbar fusion is designed to conjoin 2 or more spinal bones together into 1 bone. Spinal fusion surgery reduces the ability for the affected vertebra or vertebrae to move too far in any direction. During spine fusion surgery, Dr. Rozbruch may use a bone graft from the hip and metal instrumentation such as screws, rods, or plates to successfully fuse 2 or more vertebrae together. In children, it is possible that only a bone graft is necessary for a successful lumbar spine fusion.
What should I expect after recovering from a nonsurgical spondylolysis treatment?
The most important step after any spondylolysis treatment is to allow for plenty of rest. This will help the spine heal properly. After resting until your back has healed, it may be suggested that you begin physical therapy for 4-6 weeks to help regain strength in your lower back. The initial goal of physical therapy is to help manage any symptoms of back pain or discomfort. Your physical therapist can create exercises and regimens that help alleviate lower back pain and stiffness. As you progress during physical therapy, your physical therapist will begin adding more complicated exercises in to further strengthen your lower back.
Physical therapy can help you avoid future spinal injury or pain by teaching you proper ways to partake in activities. If you are an athlete, you may work closely with a sports coach to learn how to properly participate in the sport again without jeopardizing the health of your spine. Physical therapy can positively alter your sports technique to help avoid future injury. At the end of physical therapy, patients will be given an exercise regimen to continue that will help regain lower back strength. These exercises will also be designed to help relieve pain if your symptoms are to flare up again in the future.
What should I expect after recovering from spondylolysis surgery?
Following spondylolysis surgery, physical therapy will also be prescribed to recover from your procedure. Depending on your specific spondylolysis surgery, you may need to stay at the hospital for a couple of days before being released. Physical therapy after spondylolysis surgery will initially be designed to help reduce pain and inflammation, while helping you learn how to sit up, lie down, and perform basic movements without aggravating your lower back pain. For patients who have also undergone lumbar fusion surgery, physical therapy may be postponed until your spine has had adequate time to heal.
How can I learn more about spondylolysis and a spondylolysis treatment?
To learn more about spondylolysis and a spondylolysis treatment, please request an appointment online or contact Dr. Rozbruch’s orthopedic office at 917.975.0061. Prior to an office visit, please fill out Dr. Rozbruch’s patient forms to expedite your first visit.