What Is Spondylolysis?
"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 .
Some cases of spondylolysis may be asymptomatic at times . 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.
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.
How common is Spondylolysis?
Symptoms that always occur with Spondylolysis:
- Lower back pain
Symptoms that never occur with Spondylolysis:
- Back pain that shoots down the leg
- Back pain that shoots to the butt
Spondylolysis is also known as
- Sometimes confused with spondylitis, spondylosis, or spondylolisthesis
Symptoms of spondylolysis can be back-specific or more widespread.
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.
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 is found in the fifth lumbar (L5) vertebra in the low back in 85 to 95 percent of cases. It may be foundin the L4 in five to 15 percent of cases, and may also affect the cervical, or neck, vertebrae . The four causes of spondylolysis include:
- 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 . 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, normal wear-and-tear can result in stress fractures at these connecting surfaces.
- Hereditary traits: Some individuals are born with a tendency toward 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 and/or twisting of the lower back. This can happen during hard, repetitive physical work or during sports training.
Who is most likely to be 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 and/or twist the low back . 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
Treatment Options and Prevention for Spondylolysis
Spondylolysis is a long-term condition, but sometimes the fractures heal well enough that it is considered cured . Getting treatment when the first symptoms appear can help prevent more serious fractures. Possible treatments include rest, over-the-counter medication, procedures, careful exercise, and rehabilitation.
You should not be immobile but should avoid strenuous exercise, training, and physical work until your fractures are healed. Avoid being completely inactive because it can lead to:
- Weakening and atrophy of muscles
- Stiffness in joints and muscles
- Further weakening and thinning of bones
Pain medication can be taken over-the counter to ease pain and reduce swelling and inflammation. Non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen (Advil) or naproxen (Aleve) may be helpful.
Procedures may be necessary, including:
- Steroid injections: These are administered into the joints between the vertebrae can help ease pain and inflammation.
- Surgery: In more severe cases, surgery may be recommended in order to repair damage and help alleviate discomfort.
If your physician has cleared you for exercise, she may suggest you strengthen your abdominal muscles, or core, by staying active and working 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 for warming up before play or training starts.
- Monitor younger individuals: Children and teenagers involved in heavy training or elite sports should be monitored by a physical therapist or a specialist in sports medicine.
- Be cautious: The back is fundamental to your body's functioning and movement and should be cared for. Activities should be resumed gradually. Do not "push through the pain."
Spondylolysis may require physical rehabilitation, which takes three to six months .
Goals and details of rehabilitation include:
- Protecting the damaged vertebrae: This includes from stress and rotation.
- Allowing fractures to heal
- Gradually resuming normal activity: This is once pain and inflammation are gone.
- During the first week: Expect to rest with only very mild activity.
- During the following six to 12 weeks: You may wear a supportive brace. Back braces might be prescribed for protection and stabilization while fractures heal.
- Psychological support: This may be needed for the depression that sometimes occurs due to being kept out of sports or other activities that are important to your quality of life.
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 has caused several small stress fractures in the vertebrae. This 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 .
If spondylolysis is interfering with your life
If not treated, even mild spondylolysis can make it difficult to participate in sports or perform normal activities such as walking or driving. If conservative methods do not help, you may be referred for surgery.
If spondylolysis causes pain
Low back pain is common in humans simply 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 in sports training, it should be seen by a medical provider.
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?
The above questions are also covered by our A.I. Health Assistant.
- Spondylolysis and Spondylolisthesis. American Academy of Orthopaedic Surgeons: OrthoInfo. OrthoInfo Link. Published September 2016.
- 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.
- Peng B. Natural History of Lumbar Spondylolysis-Advances and Concerns. International Journal of Orthopaedics. 2016;3(4):591-594. International Journal of Orthopaedics.
- 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.
- Leahy M. Treating Spondylolysis in the Adolescent Athlete. American Academy of Orthopaedic Surgeons. AAOS Link.
- Spondylolysis: Outlook/Prognosis. Cleveland Clinic. Cleveland Clinic Link. Published October 14, 2014.
- Garet M, Reiman MP, Mathers J, Sylvain J. Nonoperative Treatment in Lumbar Spondylolysis and Spondylolisthesis. Sports Health. 2013;5(3):225-232. PubMed Link
- 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.