Spondylolysis
What Is Spondylolysis?
Spondylolysis results when cracks or fractures occur in the pars interarticularis, the portion of the
lumbar spine that joins the upper and lower joints together of a single vertebra (individual bone in
the spine).
 Spondylolysis is the middle of 3 stages of injury to the pars interarticularis, with the first
(least serious) being a stress reaction and the third (most serious) being actual slippage
of vertebra(e), or spondylolisthesis.
 In the vast majority of children, the pars interarticularis is normal. But certain patients begin
to experience abnormal growth and development in the pars interarticularis, usually after
age 8.
 In patients with spondylolysis, stress reaction or injury may occur with the excessive wear
and tear from activities of daily living, sports, or a fall. Gymnastics and heavy weightlifting
are particularly culpable aggravators of spondylolysis symptoms.
 Certain ethic groups, like Alaskan Indians, are prone to spondylolysis due to a genetic
weakness to the bone.
Symptoms
As with any spine condition or deformity, symptoms can vary from patient to patient but generally
include the following:
•
Persistent lower back pain
•
Stiffness in the back or legs
•
Hamstring muscle tightness.
Diagnostics
X-ray imaging typically confirms bony abnormality, particular in cases of spondylolysis and
spondylolisthesis. However, with a stress reaction, an x-ray may not reveal any abnormality.
Treatment
The goals of treatment include relieving pain, decreasing acute spasm, and restoring spinal
flexibility. The prognosis is affected by slippage of one vertebra on another (spondylolisthesis).
 Patients with less than 50% slippage tend to fare well through adolescence.
 With slippage of 50% or greater, the potential for additional slippage with growth and aging
is greater.
Nonoperative Treatment
Most spondylolysis patients will respond well to conservative (nonoperative) medical
management. Post-treatment “maintenance” exercises like truncal core muscle strengthening
(pilates or yoga) may be prescribed to condition the muscles and minimize reinjury.
•
•
•
•
(therapist will
"crunches”)
Anti-inflammatory drugs
Brace wear
Activity modifications
Physical therapy treatment that incorporates truncal core strengthening exercises
caution patient on avoiding hyperextension maneuvers and excessive abdominal
Operative Treatment
If the pain, spasm, or slippage increases despite conservative management, then the surgeon
may discuss several potential surgical options with the patient:
1) Spinal fusion (for spondylolisthesis)
 For a majority of children and adults, fusing the fifth lumbar vertebra to the sacrum (the
most common vertebrae involved in adolescents with spondylolisthesis) is the preferred
surgical option.
 The fusion involves removing the loose bony fragments and placing bone graft that will
lead to the 2 vertebrae “fusing together" to prevent any further slippage. Specially
designed screws and rods may be needed to hold the vertebrae in place to help the two
bones fuse together.
 A perforated, hollow cylinder called a “cage” is sometimes required. The “cage” is filled
with bone matter and placed in the disc space between the two vertebrae to increase the
likelihood of fusion.
 Bones may be realigned depending on how much one vertebra has slipped forward on
the other. The most important steps are restoring stability and making sure the nerves
have no pressure on them.
2) Pars repair
At times the pars fracture can be repaired without fusing 2 vertebrae together. This involves
removing any scar material that may have developed in thefracture site of a single vertebra, and
stabilizing the 2 sides of the fracture to restore normal anatomy.
Spondylolisthesis <separate menu link under Spondylolysis>
Isthmic spondylolisthesis results when a fracture gap at the pars interarticularis (the junction of
the upper and lower lumbar spine joints of one vertebra) widens. Widening of the gap leads to the
fifth lumbar vertebra shifting forward on the part of the pelvic bone called the sacrum; this is known
as “slippage.”
Degenerative spondylolisthesis results when wear and tear breaks down the pars
interarticularis, causing slippage of one vertebra on another. This is more common in adults and
most commonly occurs between the fourth and fifth lumbar vertebrae.
Symptoms


The primary symptom is pain related to nerve root irritation, which can occur in the lower
back, buttocks, or legs.
Numbness or a tingling sensation of the legs
Treatment
Nonoperative Treatment
Post-treatment “maintenance” exercises like truncal core muscle strengthening (pilates or yoga)
may be prescribed to condition the muscles and minimize reinjury.
•
•
Anti-inflammatory drugs
Brace wear
•
Activity modifications
•
Physical therapy treatment that incorporates truncal core strengthening exercises
(The therapist will caution the patient on avoiding hyperextension maneuvers and excessive
abdominal "crunches”)
Operative Treatment
If the pain, spasm, or slippage increases despite conservative management, then the surgeon
may discuss spinal fusion with the patient:
 For a majority of children and adults, fusing the fifth lumbar vertebra to the sacrum (the
most common vertebrae involved in adolescents with spondylolisthesis) is the preferred
surgical option.
 The fusion involves removing the loose bony fragments and placing bone graft that will
lead to the 2 vertebrae “fusing together" to prevent any further slippage. Specially
designed screws and rods may be needed to hold the vertebrae in place to help the two
bones fuse together.
 A perforated, hollow cylinder called a “cage” is sometimes required. The “cage” is filled
with bone matter and placed in the disc space between the two vertebrae to increase the
likelihood of fusion.
Bones may be realigned depending on how much one vertebra has slipped forward on the other.
The most important steps are restoring stability and making sure the nerves have no pressure on
them.