Spondylolysis

Young children and teenagers who participate in certain sports are prone to a stress fracture injury called spondylolysis – a common cause of lower back pain among the young. Sports such as gymnastics, ballet, volleyball, weightlifting, and football are often involved. However, spondylolysis can happen at any age.

When you or your child have back pain, it’s important to see your health care provider to find out more about what’s causing it and how to get on the road to healing.

What are the symptoms of spondylolysis?

Sometimes spondylolysis doesn’t create symptoms and you may find out you or your child have it when imaging of the back is done for another condition.

The first spondylolysis symptom to appear is often lower back pain that feels like strained muscles. Back stiffness or pain that moves from the back to the thighs or butt muscles (buttocks) may follow.

Spondylolysis symptoms usually get worse with activity and get better with rest.

Sometimes spondylolysis symptoms involve the nerves, including:

• Muscle spasms or weakness
• Numbness or weakness in the legs
• Pain in the back, neck, legs, thighs or shoulders
• Pins and needles feelings in the legs
• Tingling or numbness in the back

When a nerve root is compressed by a spondylolysis injury, symptoms may include sciatica – pain that starts in the back and travels down the back of the legs.

What are risk factors for spondylolysis?

Being young and involved in active sports that involve the lower back make spondylolysis more likely to happen. Growth spurts where the bones are growing and changing quickly also make spondylolysis more likely.

Another risk factor is having a job that involves repetitive back motions such as painting or a job that involves a lot of lifting. Repeated back injuries also increase spondylolysis risk.

Spondylolysis can happen to people of all ages and it can also happen without an injury or activity. Some people are more prone to a pars fracture because they have thinner bones in their spines, including Alaska Natives.

Diagnosis of spondylolysis

Spondylolysis diagnosis starts with a physical exam where your doctor takes your family medical history and asks about your potential spondylolysis symptoms. They’ll also examine your back and spine to evaluate:

• Areas of tenderness
• Muscle spasms
• Muscle weakness
• Range of motion

While you’re in the office, they’ll observe your posture and gait (the way you walk). They may order imaging tests such as X-rays, MRIs or CT scans.

Your doctor or surgeon will need to determine whether your symptoms are caused by spondylolysis or another problem such as a herniated disc or pinched nerve.

Treatment for spondylolysis

The purpose of spondylolysis treatment is to reduce pain, allow fractures to heal and permit the eventual return to sports or other activities. Nonsurgical treatments are usually all that’s needed for people to recover, but surgery is sometimes needed.

Nonsurgical treatment for spondylolysis

Nonsurgical spondylolysis treatments your doctor may recommend include:

• Bracing or otherwise supporting the back
• Corticosteroid medications to reduce inflammation
• Pain medications (over-the-counter or prescription)
• Physical therapy exercises
• Rest and pausing sports activities

During nonsurgical treatments, your doctor will order periodic X-rays to make sure your back remains stable enough to heal. X-rays also show whether the injury has caused spondylolisthesis – where one vertebra slips forward over another. If spondylolisthesis develops, you’ll need different treatments.

Surgical spondylolysis treatment

When spondylolysis doesn’t heal using nonsurgical treatments, your doctor may recommend surgical spondylolysis treatment. Spine surgery for spondylolysis stabilizes the spine and relieves severe back pain.

Fusion surgery is the most frequent surgical spondylolysis treatment. In fusion surgery, two vertebrae are joined using bone grafts and sometimes metal screws and rods so the two bones will work as one. Your flexibility may be decreased slightly after surgery.

After successful treatment, your doctor will schedule regular follow-up visits to monitor your condition and take X-ray images. Your physical therapist or doctor may recommend that you continue doing exercises that stretch and strengthen the back and abdominal muscles to help prevent repeat injuries or complications such as deep vein thrombosis.

What’s the recovery time for spondylolysis surgery?

The recovery period for spondylolysis surgery may last up to several months. You’ll probably be encouraged to be up and walking shortly after surgery, but you’ll need to take it easy for the early period.

Your doctor will let you know when it’s OK to slowly resume normal activities. After spondylolysis surgery, you shouldn’t return to active sports until you get permission from your surgeon or doctor.

Most people recover fully from spondylolysis whether they have surgical spondylolysis treatment or are treated with nonsurgical techniques.