Spondylolysis Symptoms, Causes & Treatment Options

Spondylolysis involves defect or damage at the rear of each vertebra caused by bone defects, spinal wear and tear, hereditary traits, or overuse of the lower back.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. Questions Your Doctor May Ask
  7. References

What Is Spondylolysis?

Summary

"Spondylos," refers to the vertebrae, and "lysis," means destruction or dissolving. Spondylolysis is a defect or damage via a stress fracture in one of the vertebrae of the spinal column. It commonly affects children or adolescents who are active or frequently participate in sports [1].

Some cases of spondylolysis may be asymptomatic at times [2]. Presenting symptoms include lower back pain, muscle spasms, pain that worsens with exercise, a limited range of motion, a swayback posture, and an awkward gait.

Treatments include rest, over-the-counter medications, responsible exercise, possible procedures, and rehabilitation.

Recommended care

You should visit your primary care physician who will coordinate your care with a muscle and bone specialist (orthopedic surgeon). Treatment for this condition is usually conservative, including pain medication, a break from sports and other activities until pain subsides, as well as physical therapy in some cases.

Spondylolysis Symptoms

Symptoms of spondylolysis can be back-specific or more widespread.

Back-specific symptoms

There are certain symptoms of spondylolysis that stem directly from the back, such as:

  • Lower back pain: The classic symptom of spondylolysis is lower back pain, often on just one side.
  • Muscle spasms: People who have more severe cases of spondylolysis may have muscle spasms in their back.
  • A swayback posture: People with spondylolysis may walk with or maintain a "swayback" posture, which strains the lower back by increasing the curvature of the low back.

Other symptoms

Since the back is essential to much of your overall health and performance, some other, more widespread symptoms may be present, including:

  • Pain that worsens during exercise: In people who have spondylolysis, it is common for pain to worsen during exercise and temporarily improve with rest.
  • Limited range of motion: The ability to move the leg forward, backward and outward is limited in people with spondylolysis.
  • Awkward gait: Someone who has spondylolysis may walk with an awkward gait.
  • Absence of symptoms: People with spondylolysis may have little or no discomfort until there is additional physical stress on the bones. It may also present during a growth spurt in the teenage years.

Spondylolysis Causes

Spondylolysis is found in the fifth lumbar (L5) vertebra in the low back in 85–95% of cases. It may be found in the L4 in 5–15% of cases, and may also affect the cervical, or neck, vertebrae [3]. Four causes of spondylolysis include the following.

  • Bone defects: Having a defect in the vertebrae means that the bone is abnormally thin at its connection points, which causes small cracks, called stress fractures [4]. They may occur on one or both sides of the vertebrae.
  • Spinal wear-and-tear: The spine is meant to be strong and flexible. Individual bones, or vertebrae, allow for both straight and bent positions. However, over time, wear-and-tear can result in stress fractures at these connecting surfaces.
  • Hereditary traits: Some individuals are born with a tendency for weaker, thinner bones in the spine, which means their spondylolysis is a congenital (from birth) condition that they inherited.
  • Overuse of the lower back: A primary cause of spondylolysis is constant hyperextension — overstretching or twisting — the lower back. This movement can happen during hard, repetitive physical work or during sports training.

Who is most often affected?

Spondylolysis is likely to affect anyone who:

  • Has inherited weakness of vertebral connections
  • Has a physically demanding job
  • Participates in strenuous or repetitive exercise: Such as playing sports that repeatedly stretch or twist the low back [5]. These include football/soccer, baseball, tennis, diving, gymnastics, ballet, wrestling, weightlifting, pole vaulting, etc.
  • Is a male younger than 25
  • Is a woman: However, this is less frequent.
  • Is a child or teenager: Since their skeletal structure has not entirely matured into hard bone and can be more vulnerable to stress and breakdown

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Treatment Options and Prevention for Spondylolysis

Spondylolysis is a long-term condition, but sometimes the fractures heal well [6]. See a physician when the first symptoms appear to help prevent more severe fractures. Possible treatments include rest, over-the-counter medication, procedures, careful exercise, and rehabilitation.

Rest

Avoid strenuous exercise, training, and physical work until your fractures heal. Being completely inactive can lead to the following, however.

  • Weak muscles or atrophy
  • Joint stiffness and muscle stiffness
  • Further weakening and thinning of bones

Over-the-counter medication

Pain medication can be found over-the-counter to ease pain, swelling, and inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve) may help.

Procedures

Procedures may be necessary, such as the following.

  • Steroid injections: These injections are administered into the joints between the vertebrae can help ease pain and inflammation.
  • Surgery: In more severe cases, surgery is required to repair damage and soothe discomfort.

Careful exercise

If your physician has cleared you for exercise, he or she may specifically suggest you strengthen your abdominal muscles, or core, with a physical therapist. Your core muscles in your abdomen and back help support and protect the bones of the spine. While exercising, keep these tips in mind.

  • Keep it low-impact: Choose low-impact sports and activities that will not stress the low back.
  • Warm-up: Allow time to warm up before play or training starts.
  • Monitor younger individuals: Consult a physical therapist or a specialist in sports medicine for children and teenagers involved in heavy training or elite sports.
  • Be cautious: Resume activity gradually. Do not "push through the pain."

Rehabilitation

Spondylolysis may require physical rehabilitation, which takes three to six months [7]. Goals and details of rehabilitation include the following.

  • Protect the damaged vertebrae: Try to limit stress and rotation.
  • Allow fractures to heal
  • Gradually resume activity: Once pain and inflammation subside, resume movement carefully.
  • During the first week of rehab: Expect to rest with only very mild activity.
  • During the following six to 12 weeks of rehab: You may wear a supportive brace. Back braces can protect and stabilize your back while fractures heal.
  • Psychological support: Support can help with depression that sometimes occurs due to activity changes.

When to Seek Further Consultation for Spondylolysis

If you have suffered an injury, pain is significantly interfering with your life, or you cannot find relief, you should consult your physician.

If spondylolysis causes misalignment of vertebrae

If not treated, spondylolysis can progress until it causes several small stress fractures in the vertebrae. These fractures may weaken one or more of your vertebrae until they shift out of place and no longer line up correctly with the other vertebrae of the spine. This misalignment is called spondylolisthesis and may require surgery [8].

If spondylolysis is interfering with your life

If not treated, even mild spondylolysis can make it difficult to participate in sports, walk, or drive. If conservative methods do not help, you may need surgery.

If spondylolysis causes pain

Low back pain is common from walking upright, so mild low back soreness after exercise is not unusual at any age. However, if it constantly recurs, seems to be getting worse, or is happening in a child or teenager who trains, see a physician.

If you suffer a back injury that does not resolve with a few days rest

If you suffer a back injury or have low back pain that does not clear up with a day or two of rest, see your physician right away.

Questions Your Doctor May Ask to Determine Spondylolysis

To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.

  • Any fever today or during the last week?
  • How severe is your back pain?
  • Have you ever injected drugs?
  • Is your lower back pain constant or come-and-go?
  • How long has your back pain been going on?

If you've answered yes to one or more of these questions

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References

  1. Spondylolysis and Spondylolisthesis. American Academy of Orthopaedic Surgeons: OrthoInfo. OrthoInfo Link. Published September 2016.
  2. Syrmou E, Tsitsopoulos PP, Marinopoulos D, Tsonidis C, Anagnostopoulos I, Tsitsopoulos PD. Spondylolysis: A Review and Reappraisal. Hippokratia. 2010;14(1):17-21. PubMed Link.
  3. Peng B. Natural History of Lumbar Spondylolysis-Advances and Concerns. International Journal of Orthopaedics. 2016;3(4):591-594. International Journal of Orthopaedics.
  4. Astur DC, Zanatta F, Arliani GG, Moraes ER, Pochini AD, Ejnisman B. Stress Fractures: Definition, Diagnosis and Treatment. Revista Brasileira de Orthopedia. 2016;51(1):3-10. PubMedLink.
  5. Leahy M. Treating Spondylolysis in the Adolescent Athlete. American Academy of Orthopaedic Surgeons. AAOS Link.
  6. Spondylolysis: Outlook/Prognosis. Cleveland Clinic. Cleveland Clinic Link. Published October 14, 2014.
  7. Garet M, Reiman MP, Mathers J, Sylvain J. Nonoperative Treatment in Lumbar Spondylolysis and Spondylolisthesis. Sports Health. 2013;5(3):225-232. PubMed Link
  8. Panteliadis P, Nagra NS, Edwards KL, Behrbalk E, Boszczyk B. Athletic Population with Spondylolysis: Review of Outcomes Following Surgical Repair or Conservative Management. Global Spine Management. 2016;6(6):615-625. PubMed Link.