What is Spondylolysis?

Spondylolysis is the medical term for a spine fracture or defect that occurs at the region of the pars interarticularis. The pars interarticularis is region between the facet joints of the spine, and more specifically the junction of the superior facet and the lamina. Spondylolysis is one of the most common causes of low back (lumbar) pain in adolescents. It may have been caused by a childhood fracture that did not heal causing pain. Many young athletes pushing themselves to excel in sports like football or gymnastics may experience minor sports-related aches such as muscle or back pain. When persistent back pain interferes with participation in a favorite sport, however, it may be an indication of the presence of spondylolysis.

Left untreated, spondylolysis can develop into spondylolisthesis, a condition where spinal vertebrae slip over one another resulting in pressure on the nerves and causing nerve stenosis.

What are the main symptoms of Spondylolysis?

Lower back pain is the most common symptom of spondylolysis. It usually gets worse during exercise or other physical activity, especially those where someone leans back a lot. Spondylolysis also can cause buttock and leg pain, and tight hamstrings.

Sometimes, kids and teens with spondylolysis won’t have any obvious symptoms and don’t realize that they have the condition.

Young people are most at risk for spondylolysis because their bones are still growing. Kids and teens who play sports and do activities that can strain the lower back or that involve a lot of leaning back — like football,  weightlifting, gymnastics, volleyball, ballet, golf, and wrestling –  are especially prone to this injury.

What can I do if my child shows symptoms of spondylolysis?

If you notice any symptoms, it is advisable to consult your pediatrician. If he/she considers them worrisome, he/she will refer you to a specialized Orthopedic Spine Surgeon, who, after an evaluation and a series of tests, will indicate the appropriate treatment. Each case is different and therefore an individualized approach is required. The doctor will inform you about the appropriate treatment. In most cases, simple monitoring is needed. If the condition remains stable, the doctor will monitor the progress of the child’s health into adulthood.

How is Spondylolysis diagnosed?

At first, the doctor will take a complete medical history and continue with a physical examination and X-rays. For more detailed diagnosis and depending on the case, other imaging tests (such as an MRI or a CT scan) may be done to get more detailed information about the child’s spine. The doctor may also suggest a CT Bone Scintigraphy or SPECT to make a better and more thorough diagnosis of the course of the condition and the appropriate treatment that the patient should follow.

What is the treatment of Spondylolysis?

Cessation from sports activities & painkillers intake

If your child has spondylolysis, the doctor may recommend:

• Plenty of rest
• A break from sports and other strenuous activities (for about 3-6 months)

Physical Therapy

The patient feels the beneficial properties of the therapeutic ultrasounds in combination with the appropriate exercises indicated by the physical therapist. This treatment helps reduce pain and speed up recovery.

Injections

This method of treatment mainly helps to manage pain so as to significantly improve the quality of patients’ everyday life. It is mainly indicated for adults.

Surgery

The doctor will assess the case and suggest the appropriate surgical treatment. In case surgery is considered necessary, your Spine Surgeon will take the medical history and inform you about this procedure. Surgery is usually chosen when the pain affects the patient’s functionality and quality of daily life. Finally, the doctor will talk to you about the risks and benefits of this type of operation and the post-operative stage.

The surgical treatments of spondylolysis vary according to the symptoms that are being caused and how your activities are affected. If the pain is mild and everyday life is not affected you don’t have to perform a surgery. If the pain is more severe and you can’t do the activities you want to do, then you may decide to discuss about surgery.

The exact operation will be decided with your specialist spine surgeon. The risks and advantages as well as the post operative care will depend on the type of surgery required.

Depending on the case, we have the following options:

1. Placing a screw (Buck’s screw) or wire (Scotts’ wire) across the gap in the bone as well as bone grafting the gap. This is to try and repair the spondylolysis gap (get it to heal across).
2. Placing a hook and a screw in the main bone of the spine and then a rod that compresses (squeezes) the gap. Again the gap will be grafted and this is to try and repair the spondylolysis gap.
3. Sometimes the gap is dealt with by fusing that whole segment in the spine. This can involve just using bone graft or bone graft and rods and screws (a spinal fusion).

Your specialist spine surgeon will help you decide which is the best surgical option for the treatment of spondylolysis. Usually surgical repair is performed in people under 25 years of age with a normal disc and minimal or no spondylolisthesis. For the rest of the patients who do not respond to conservative treatment, the segmental spinal fusion is the best surgical option.