Spondylolysis is simply described as a stress fracture of the back. It is the usual root of physical back pain among children, teenagers and young adults with active lifestyles. This is a non-displaced form of stress fracture of the spinal vertebra.
Among children or teenagers, it typically arises from a fault or stress fracture involving the pars interarticularis of the vertebra. Take note that the pars interarticularis is the region of the vertebra amidst the inferior and superior facets.
Around 90-95% cases of spondylolysis involve the L5 vertebral level. The lesion usually heals fully. In a small percentage of cases where nonunion of the fracture occurs, a fibrous mesh connective tissue forms instead of bone.
What are the indications?
Spondylolysis generally causes the following symptoms:
- Abrupt onset, unilateral back pain, usually in the belt line. It is sharp at first but becomes dull later.
- Pain radiating to the thigh or buttock
- Pain that is worsened by standing or arching particularly with increased training
- Pain that is relieved by rest
- Normal neurological signs
- Exaggerated back arch and taut hamstrings
Management of spondylolysis
The treatment for spondylolysis initially includes conservative measures and aims to minimize the pain and promote healing.
A variety of treatment options to relieve the pain and inflammation are used such as application of ice, acupuncture, TENS machine, soft tissue massage, de-loading taping techniques and using a supportive brace.
The inflammation can be minimized by avoiding any activities that triggers the pain along with cold therapy and measures or exercises the unload the inflamed structures. A non-steroidal anti-inflammatory drug (NSAID) can be given to lower the inflammation.
As the inflammation and pain settles, restoring the normal range of movement and posture to the back is started. As for tight leg and back muscles, the individual is assessed and stretching is started to allow normal and full movement of the back and legs.