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Lumbar Spondylolysis

What does “Spondylolysis” mean?

The word “spondylolysis” is a combination of the Greek words “spondylos”, meaning “spine”, and “lysis”, meaning “break or fracture”. Together the words mean spine fracture.

What is a Spondylolysis?

Spondylolysis is a fracture of the pars interarticularis, which is the weakest part of the spinal vertebrae. The pars interarticularis connects the lamina of the vertebrae to the pedicle. A spondylolysis can be thought of as a stress fracture.

How common is a Spondylolysis?

It is estimated that 3-6% of the population have a spondylolysis defect in the spine. Only a small percentage of these patients have significant low back pain.

Where in the spine does Spondylolysis happen?

The great majority of them happen in the lowest vertebrae of the lumbar spine, at the L5/S1 level.

At what age is a Spondylolysis typically diagnosed?

The typical age of diagnosis is 15-16 years of age. Individuals under the age of 26 are most likely affected. It is one of the most common causes of low back pain in children.

How does a Spondylolysis fracture happen?

A hyperextension (extreme backward bending) of the spine with a downward force appears to be the most likely mechanism producing this kind of fracture.

There also appears to be a genetic component to spondylolysis as it does run in some families. Males are more commonly affected than females.

Here are some sports activities which predispose the spine to hyperextension injuries which can cause spondylolysis:

  1. Gymnastics
  2. Football
  3. Weightlifting
  4. Wrestling
  5. Diving
  6. Tennis

Do Spondylolysis fractures heal?

Unlike other fractures in the body, spondylolysis stress fractures of the spine typically do not heal. One of the reasons for that is the constant force of weight on this part of the spine. The spine never gets a break long enough to have a chance to heal.

Also, the bone of the pars interarticularis is very thin and does not heal easily.

What symptoms do patients with a Spondylolysis have?

Patients who suffer from a spondylolysis defect and do have symptoms, may complain of the following symptoms:

  1. Low-back pain, typically comes and goes
  2. Low-back spasms
  3. Pain worsened with bending, twisting and lifting
  4. Pain radiating from the spine to the hip and buttock
  5. A feeling of instability in the spine

How does a Spondylolysis cause a Spondylolisthesis?

Some spondylolysis defects will allow the front and the back of the affected vertebrae to separate. This causes a forward slippage of one vertebra on another, which is called a spondylolisthesis.

How is a Lumbar Spondylolysis diagnosed?

Spine specialists use the information from the patient history, physical examination and spine tests to make the diagnosis of this condition.

  1. History

Many of these patients will have a history of sport injuries or lifting injuries as teenagers and may recall some specific back injuries. A history of chronic low back pain with periods of worsening pain is common in patients with a spondylolysis.

      2. Physical Examination

Here are some physical examination techniques used by doctors to diagnose a spondylolysis:

  1. Touch and pressure on the spine (palpation)
  2. Testing the spine’s motion (range of motion exam)
  3. Gait testing
  4. Sensation (sensory) testing in the legs
  5. Strength (motor) testing
  6. Straight Leg Raising test (Lesague’s sign)


      3. Imaging

Spine imaging is usually the best way to diagnose a spondylolysis

a. X-Rays

X-Rays of the spine will show the bone anatomy of the spine. A bone defect at the pars interarticularis in a spondylolysis can be seen if it is large enough.

b. CT-Scans

A CT-scan shows bone anatomy in more detail than an X-Ray. A spondylolysis which is difficult or impossible to see on an X-Ray can usually be seen on a CT scan. However the large dose of radiation must be considered.

c. MRI Scans

MRI scans can show a spondylolysis, however it is not as good as a CT scan in showing detailed bone anatomy.

4. Nuclear Bone Scans

A nuclear bone scan can show the bone reactivity of a spondylolysis. Since the fracture of the pars interarticularis does not heal, the bone inflammation at the fractured area can be seen on the bone scan. However, it does not offer any specific bone or nerve details.

How is a Lumbar Spondylolysis treated?

  1. Non-Surgical

Here are some common treatments available for patients not requiring surgery:

A. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage therapy can help with the muscle part of the painful process from a spondylolysis.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments. PT usually focuses on core strengthening techniques of the spine. Supporting and conditioning the core muscles of the spine can add stability and improve the symptoms.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories.

G. Spine Medications

Here are some of the common groups of medications which are available for this condition:

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

Muscle Relaxants

Pain Killers

Nerve pain medication

H. Injections

Here are some possible injections for spondylolysis:

  1. Pars Interarticularis Injection for Spondylolysis
  2. Lumbar Epidural Steroid Injection
  3. Lumbar Facet Joint Injection
  4. Lumbar Facet Joint Radiofrequency Rhizotomy
  5. Lumbar Trigger Point Injection
  6. Lumbar Muscle Block

      2. Surgical Options

Most patients with a Lumbar Spondylolysis have intermittent symptoms which can stabilize over time. However, for some patients spine fusion needs to be performed to help the symptoms from this disease process. This is typically only done for patients with severe and ongoing pain. These patients often have significant instability at the site of the stress fracture. Here are some potential surgical options:

1.Lumbar Translaminar Fixation

2. Lumbar fusion