Spondylolysis: What You Need to Know

Spondylolysis is a big word for a little fracture. Learn what spondylolysis is, how it happens, and how you can treat it.

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Big medical words can make patients nervous, especially when it involves the back and the spine. Spondylolysis sounds intimidating, but the truth is it’s a relatively common problem. Spondylolysis affects around one out of every 20 people. But what is it and how worried should you be if it’s your diagnosis? Read on to learn more about this condition and related conditions, and what you can do about it.

Spondylolysis is like a crack in your vertebraSpondylolysis is a hairline crack in a vertebra.

What is Spondylolysis?

Spondylolysis is a condition caused by repetitive stress or overuse. Also known as a stress fracture, spondylolysis affects a part of the lower vertebrae called the pars interarticularis

“This portion of bone connects the inferior facet joint with pedicle and superior facet joint,” explains Dr. Jonathan Krystal, Chief of Spinal Surgery at the Montefiore Spine Center Department of Orthopaedics in Bronx, NY. “When a patient develops spondylolysis, the posterior [back] elements no longer provide stabilization although the anterior [front] column remains intact. This is most commonly caused by a stress fracture and is most common in young athletes but may not present with symptoms until well into adulthood.”

Facet joints stop the spine from rotating too far or moving too far backwards or forwards. Repetitive stress on those joints is the cause of stress fracture in those joints and spondylolysis. It’s very common in young athletes, especially those of high school age. 

Spondylolysis vs Spondylosis

It’s easy to confuse spondylolysis with spondylosis, but the truth is there are two different conditions. Spondylosis is not a fracture—it’s osteoarthritis of the spinal joints, an age-related degenerative condition that is far more common in people over the age of 40. In fact, 80% of people over the age of 85 have spondylosis in their cervical spine.

“[Spondylosis] describes degenerative changes in the spine, and does not denote fracture or instability,” clarifies Dr. Krystal.  

Spondylolysis vs Spondylolisthesis

To confuse things even more, there is a third, similar-sounding term: spondylolisthesis. This condition occurs when a vertebra slips out of place and onto the vertebra below it. The two are related, but not the same, as Dr. Krystal explains: “While spondylolysis can cause spondylolisthesis (anterior translation of one vertebra on another) they are separate pathologies.” 

When a stress fracture causes the vertebrae to slip, it leads to spondylolisthesis. Degenerative conditions can also cause this slip. Spondylolisthesis can also result in a compression or pinching of spinal nerves. 

Spondylolysis Causes and Risk Factors

Right now, medical professionals don’t know the exact cause of spondylolysis. They have identified two main risk factors: repetitive stress and genetics.

Repetitive stress on the lower back is the most common cause of spondylolysis; Dr. Krystal calls it “repetitive lumbar spine extension.” Athletes, weightlifters, dancers and even people who drive a lot (especially for work) are at higher risk for developing this condition. 

Genetics are another risk factor. Some people are born with thinner vertebrae than other people. This thinness makes them more susceptible to stress fracture and thus spondylolysis.

Additional risk factors include gender—men are twice as likely to get it than women—and being of Alaskan Eskimo descent. There are other conditions that can also increase the likelihood of spondylolysis, including spina bifida occulta and osteogenesis imperfecta.

Spondylolysis Symptoms and Diagnosis

While you may develop spondylolysis as a teenager, you may not know you have it until you are older. Spondylolysis is often asymptomatic—it doesn’t hurt or cause other symptoms—and doctors may not actually diagnosis it until you are being checked or treated for a different condition, including spondylolisthesis.

“When spondylolysis is symptomatic, it often presents as back pain, particularly in a young athlete,” says Dr. Krystal. You might also feel pain in the buttocks and thighs, and is usually a dull ache, though sometimes more severe pain occurs.

At your initial doctor visit, you will be checked for areas of pain and tenderness, weakness or muscle spasms, and your range of motion. Your doctor will also look at how you walk, since people with spondylolysis can sometimes walk stiffly or stand awkwardly.

Imaging studies are next, as Dr. Krystal explains. “Diagnosis can generally be made with plain X-ray—specifically, oblique views of the lumbar spine can show defects in the pars interarticularis. CT scan is more sensitive but is rarely necessary for complete diagnosis.”

Another kind of scan may also be used. Called a SPECT scan, the acronym stands for single-photon emission computerized tomography. Since this kind of scan uses radiation, however, many doctors are hesitant to use it for younger patients.

Spondylolysis Treatment

Physical therapy involving stretching and strengthening of muscles is an important part of treatment and rehabilitation. It can also help to prevent the condition in people who are at higher risk. Avoiding the activity that cause the problem is also important. Treatment helps to relieve symptoms, not necessarily to heal the problem itself, though.

“For treatment and prevention, we mainly focus of hamstring stretching and core strengthening exercises,” says Dr. Krystal. “Athletes may need to take time away from their sport in order to more completely rehab.”

In some cases, surgery can help. Dr. Krystal explains the most common procedures: “A small subset of patients may benefit from a direct repair of the pars interarticularis with screws and bone graft. Spinal fusion is also commonly used, particularly when there is already a spondylolisthesis and nerve root compression.”

Other forms of treatment include:

  • Wearing spinal corset for 6 to 12 weeks to limit movement and lessen stress on the pars interarticularis
  • Additional physical therapy including stretching the hip flexors, hamstrings, and quadriceps
  • Increasing core strength
  • Resistance training
  • Ice/heat therapy
  • Medical such as NSAIDs 
  • Steroid injections
  • Massage and osteopathic or chiropractic manipulation

People who are asymptomatic may require no treatment at all.

Overall, a diagnosis of spondylolysis typically leads to easy-to-manage treatment and an excellent prognosis, even for people who have surgery. Most people can eventually return to their regular activities, including sports. In fact, according to a 2018 article, “92% of the adolescent athletes were able to return to competitions when they are treated conservatively, and 90% of the time when managed surgically.” Like many other conditions that cause back pain, conservative treatment that includes lots of rest and physical therapy is your best bet for overcoming spondylolysis.

Updated on: 08/26/21
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