spondylolysis

Introduction

A fracture or cleft in the vertebral body, often through the posterior vertebral arch, loosening its normally firm attachment to contiguous vertebrae.

Etiology

• recurrent microtrauma during excessive lumbar hyperextension
• congenital

Epidemiology

• gymnasts, dancers, divers, weightlifters, football players (lineman), other sports activities
• 50% of adolescent athletes evaluated for low back pain
• also occurs in general population
• Caucasions > blacks
• male > female

Pathology

• most often involves L5 vertibrae

Clinical manifestations

• low back pain, exacerbated by lumbar hyperextension
• may be asymptomatic
• unilateral pain localized to side of involvement
• straight leg raising may be impaired on the side of involvement
• forward bending may be impaired
• hamstring tightness may be observed

Radiology

• X-ray of LS spine
• bone scan may detect early fracture & distinguish old vs new fracture

Complications

• progression to spondylolisthesis

Differential diagnosis

• vertebral fracture
  • trauma, osteoporosis, malignancy
  • point tenderness
• vertebral disk injury
  • pain radiating to lower extremity, paresthesias
  • disc herniation visible on X-ray
• Schmorl modes
  • older patients with degenerative disc disease (may be seen in younger patients)
• sacroiliitis: buttocks pain, morning stiffness

Management

• treatment is controversial
• referral to orthopedic surgeon
• rest
• lumbar brace to prevent hyperextension
• indications for surgical fusion
  • intractable pain
  • growing child with slippage > 50%

More general terms

• sign/symptom

Additional terms

• spondylitis
• spondyloarthropathy (HLA B27-associated arthritis, seronegative spondyloarthropathy)
• spondylolisthesis (listhesis, olisthesis)
• spondylosis

Patient information

spondylolysis patient information