Non-operative treatment of acute spondylolysis
CZ is a 15 year old hockey player checked in back. Acute back pain
started at the time of injury, and increased over the next week. He was
unable to play or even skate. Radiographs were interpreted as
negative.
He presented to his orthopedist, where a Technetium (Tc99) Bone scan
with SPECT imaging revealed increased uptake in the posterior
elements of L-5. CT (Computed Tomography) scan demonstrated an
acute stress fractures of the pars interarticularis, the neck of the
lamina. This region has a propensity to stress fractures due to the
forces imposed on this part of the vertebra.
Tc99 Bone Scan
Treatment involves activity modification, specialized exercises concentrating on lumbar flexion
and a hamstring stretching program. Custom molded orthosis (brace) provides immediate pain
relief. Actual healing of the fracture is successful in less than 50% of patients, but pain relief is
noted in almost all patients within 4 months. Usually sports should be avoided until pain has
completely resolved.