Spondylolysis
Information about the causes, symptoms, and treatment of a vertebral isthmus fracture.
Symptoms and Causes
Spondylolysis is a weakness or fracture of the pars interarticularis of the vertebral arch, that is, the portion of bone located at the back of a vertebra (isthmus) that connects the facet joints of the spine. Although it can occur in any area, it is most common in the lumbar region—particularly at L5 (85–95%), followed by L4 (5–15%).
Depending on which parts of the vertebra are affected, spondylolysis can be classified into two types:
- Unilateral spondylolysis: affects only one side of the vertebra.
- Bilateral spondylolysis: both sides of the vertebral isthmus are damaged.
Because it is often asymptomatic, the true prevalence of spondylolysis is unknown, although a higher incidence has been observed in children, adolescents, and individuals who participate in high-impact sports.
The prognosis for spondylolysis is good, as it generally responds well to rest and physical therapy.
Symptoms
The most common symptoms of spondylolysis, when present, include:
- Back pain, especially during physical activity.
- Pain radiating to the buttocks and legs.
- Stiffness in the hamstring muscles.
Causes
The causes of spondylolysis determine the type of condition present:
- Congenital spondylolysis: results from a malformation during fetal development, leading to the child being born with the condition.
- Acquired spondylolysis: although the exact cause is unknown, it is directly related to:
- Repetitive spinal motion.
- Trauma.
- Vertebral injuries.
- Degeneration of intervertebral discs.
Risk Factors
Risk factors that increase the likelihood of developing spondylolysis include:
- Children and adolescents, as their bones are still developing.
- Athletes engaged in high-impact sports that strain the back, such as football, weightlifting, golf, gymnastics, ballet, volleyball, and American football.
- Repetitive spinal movements.
Complications
If the body does not respond adequately to treatment, spondylolysis may lead to:
- Chronic pain.
- Loss of flexibility.
- Spondylolisthesis: displacement of one vertebra over another.
Prevention
Spondylolysis is difficult to prevent because the acquired form tends to develop gradually. To reduce the risk of vertebral injury, it is advisable to:
- Strengthen core muscles.
- Warm up before exercising.
- Stretch after workouts.
- Rest between periods of physical activity.
- Limit exercise whenever possible.
- Move the spine using proper technique in each case.
- Maintain a healthy weight.
Which specialist treats spondylolysis?
Spondylolysis is diagnosed and treated by a traumatology and orthopaedic surgery.
Diagnosis
Diagnosis of spondylolysis typically involves the following steps:
- Medical history: reviewing the patient’s medical background and lifestyle habits, as well as any symptoms experienced.
- Physical examination: palpating the back and observing the patient’s reaction when extending the spine.
- Imaging tests: these not only confirm spondylolysis but also help rule out other conditions with similar symptoms.
- X-ray: provides images of the vertebrae that help detect fractures.
- Magnetic resonance imaging (MRI) or computed tomography (CT): provide a detailed three-dimensional view of the spine, allowing small fissures or fractures to be detected.
- Bone scintigraphy: involves injecting a small amount of radioactive material intravenously, which accumulates in the bones. Images are obtained using gamma rays, and areas with higher uptake appear darker. These areas have greater biological activity, indicating bone fracture or weakness.
Treatment
Conservative treatment is generally effective for spondylolysis. The most common approaches include:
- Rest to allow the injury to heal.
- Brace or lumbar support belt to reinforce spinal support and reduce pressure.
- Medication: pain relievers or anti-inflammatory drugs.
- Physical therapy: exercises and manual techniques to relieve pain, strengthen muscles, and improve flexibility.
- Magnet therapy: the use of magnets to generate electromagnetic fields that help restore the biochemical balance of cells and promote bone tissue regeneration.
If conservative treatments are not effective, surgery may be necessary to repair vertebral damage. The most common procedures include:
- Rhizolysis: blocking the nerves in the affected area using heat generated by radiofrequency. It is an effective, minimally invasive pain treatment.
- Spinal fusion (arthrodesis): two vertebrae are fused to prevent movement and stabilize the spine. Plates or screws are typically used, which may be placed through open surgery or, when possible, minimally invasive (arthroscopic) techniques.
