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SPONDYLOLYSIS

SPONDYLOLYSIS. Outcomes. Be familiar with the definition of Spondylolysis . Be familiar with the pathology of a typical Spondylolysis . Be familiar with the ‘Scotty-dog’ image on a x-ray. Be able to explain the pathology and prognosis of typical Spondylolysis to the patient.

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SPONDYLOLYSIS

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  1. SPONDYLOLYSIS

  2. Outcomes • Be familiar with the definition of Spondylolysis. • Be familiar with the pathology of a typical Spondylolysis. • Be familiar with the ‘Scotty-dog’ image on a x-ray. • Be able to explain the pathology and prognosis of typical Spondylolysis to the patient. • Be familiar with the most widely used physiotherapy treatment protocol for a patient with typical Spondylolysis. • Be able to discuss the resuming of activities, exercises and use of a brace with the patient.

  3. Definition • Caused by a defect in the pars interarticularis without any displacement • Pars interarticularis – between the lamina and inferior facet underneath the pedicle and the superior facet above

  4. Aetiology • Congenital defect • Direct trauma to the isthmus with non adhesion • Indirect trauma with a stress fracture

  5. Spondylolysis

  6. Pathology • The vertebral column as well as the area between the pars articularis becomes narrower • A defect develops in the continuity of the vertebral body – is bridged by fibrous tissue • May lead to a potential mechanical instability • Osseous defect is bridged by connective tissue and cartilage – may exert pressure on the nerve root

  7. X-rays

  8. X-rays • Ears are shaped by the superior facet • Face by the transverse process • Eye is the one pedicle • Legs are the inferior facet • Body by the lamina • Tail and hind-legs by the opposite facet • With the defect, there is a collar around the neck

  9. Prognosis • As a result of the mechanical problem only about 80% pain relief can be accomplished is the cause of the pain is spondylolysis • Possible recurrence of symptoms

  10. Treatment • Symptomatic, patient usually experience slight to severe pain • Mobilise joints for pain relief • Central and unilateral PA Grade II for pain • Lumbar rotations Grade IV- • Relieve muscle spasm – use electrotherapy modalities • Strengthen postural muscles – lumbar stabilisers (include multifidus)

  11. Treatment • Mobilise lumbar fascia • Trigger points • Massage • Muscle stretches especially short spinal muscles • Home advice e.g. cautious with contact sport • Corset (clinical reasoning)

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