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Spondylolisis

Spondylolisis. definition. Caused by a defect in the pars interarticularis without any displacement. Degeneration of vertebra, affecting intervertebral discs Indicates a fusion of vertebrae and immobilisation. Can cause spondylolisthesis. Definition ( Continued).

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Spondylolisis

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  1. Spondylolisis

  2. definition • Caused by a defect in the pars interarticularis without any displacement. • Degeneration of vertebra, affecting intervertebral discs • Indicates a fusion of vertebrae and immobilisation. • Can cause spondylolisthesis.

  3. Definition ( Continued) • Pars interarticularis=between lamina & inferior facet underneath the pedicle and superior facet above; joins adjacent facet joints of the spine.

  4. Patho-physiology • Narrowing of vertebral column and area between pars articularis. • Defect in continuity of vertebral bodies • Bridged by fibrous tissue • Potential mechanical instability • Mechanical stress to the neural arch • Osseous defect bridged by connective tissue and cartilage • Exert pressure on nerve root.

  5. Patho-physiology (Continued) • Repetitive mechanical stress- hyperextension & trunk rotation • Mostly fatigue #’s→ repetitive stress & load • Greatest load with flex/ext movement at L5/S1 • ↓ acute pars #’s in older people→ ↑ in neural arch strength (4th-5th decade)

  6. Causes & risk factors • Congenital defect • Genetic predisposition • Direct trauma to the isthmus with non-adhesion • Indirect trauma with a stress fracture • Possible weakness in pars interarticularis • Condition: asymptomatic or slight to severe pain in lower back • ↑ incidence in athletes- gymnasts & football.

  7. Causes & risk factors ( Continued) • Incidence varies according to ethnicity, sex, sports activity, family history, occupation & relevant diseases. • Relevant diseases= spina bifida occulta, osteoporosis, osteogenesis imperfecta, cerebral palsy, Scheuermann’s disease & scoliosis. • Repetitive mechanical stress.

  8. Causes & risk factors ( Continued) • Athletes at Risk (Sport): • Gymnasts • Divers • Offensive linemen in football • Pole vaulters • Weight lifters • Wrestlers • Dancers • High jumpers

  9. Signs and symptoms • Incidence: 6% of general population • Common in adolescents • Present without any obvious symptoms • Pain with hyperextension • Pain increases- starts with sport, present in ADL’s and eventually interferes with sleep. • Hyperlordotic lower back • Tightness of hamstring mm.

  10. Signs and symptoms (continued) • Aching lower back, usually unilateral which localises around belt area. • May feel like a m. strain • Back stiffness • No nerve root pain • Symptoms eased by rest

  11. Special tests • Standing one-legged hyperextension test: Stand on the leg of the same side on which there is pain (i.e., if the pain is on the right side, stand on your right leg). Then, gently lean backwards. If the pain is reproduced, this may be a positive sign for spondylolysis.

  12. Diagnosis • The doctor will perform a physical exam. • Diagnosis is also based upon clinical history • An X-ray of the lower back can show any fractured vertebra. • CT scan or MRI to detect very small fractures.

  13. Medical management • Early diagnosis is important • Rest • Mobilise joints for pain relief: • PA grade 2 for pain • Lumbar rotations grade 4- for pain • Relieve muscle spasm • Strengthen postural muscles – lumbar & abdominal stabilisers • Mobilise lumbar fascia

  14. Medical management ( Continued) • Muscle stretches – short spinal mm.,hamstrings • Home advice regarding sport → be cautious • Corset – Boston brace • Trigger points • Massage • Cross training that is done pain-free • Anti-inflammatory medication • Electrical stimulation – heal bone • Surgery: • Spinal fusion between lumbar vertebra & sacrum

  15. Preventions of  Spondylolysis Injury • Support lower back b.m.o maintaining abdominal & back stabilisers • Do activities that do not place stress on the lower back • Avoid over-exercising • Maintain a good posture • Kinetic handling • Good back support – sit for long periods

  16. X-rays • “Scotty-dog” • Ears shaped by superior facet • Face by transverse process • Eye is one pedicle • Legs shaped by inferior facet • Body shaped by lamina • Tail and hind legs by opposite facet • With defect, collar around neck.

  17. X-ray

  18. X-ray

  19. Article Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain

  20. Article • Objective: To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back pain. • Aim: establish the prevalence of lumbar spondylolysis in the general adult population and to evaluate whether there was a significant correlation between age and prevalence. • Few studies have demonstrated the significance/ prevalence of spondylolysis in adults.

  21. Article • Population: adults older than 20 years; went for an abdominal or pelvis CT scan. Exclude patients that had a CT scan for low back pain. • Separated into age into different decades. • 2 555 evaluated, 203 positive cases • 8% prevalence. • Where: United States, July 2008- November 2008. • Made us of Multi-detector Computed Tomography(MDCT) • Images reviewed by radiologists.

  22. Article • Conclusion: • No significant ↑ in prevalence in patients older than 20 years. • Symptomatic lumbar pars defects do not occur in this population • Treatable cause of low back pain. • Study failed to support hypothesis that lumbar spondylolysis ↑ with age. • Male:female 1,5:1.

  23. References • Barnes,R.2011.NEUROMUSCULAR-SKELETAL REHABILITATION DICTATE.(Unpublished dictate.) University of the Free State , Free State. • Asher, A. 2008. Spondylolysis. (http://backandneck.about.com/od/conditions/p/Spondylosis.htm) Retrieved on 1 September 2012. • Plone Foundation. 2007. Physical Therapy Corner: Spondylolisthesis and Spondylolysis in Gymnasts. (http://www.nismat.org/ptcor/spondylo) Retrieved on 3 September 2012. • Where In City. 2011. Spondylolysis Injury. (http://www.whereincity.com/medical/topic/back-and-neck/diseases/spondylolysis-injury-102.htm) Retrieved on 3 September 2012. • Standaert, CJ and Herring, SA. 2000. Spondylolysis: a critical review. British Journal of Sports Medicine 34:415-422.

  24. References • Cluett, J. 2011. Spondylolysis. (http://orthopedics.about.com/cs/spondylosis/g/spondylolysis.htm) Retrieved on 1 September 2012. • Asher,A. 2005. Spondylolysis Definition. (http://backandneck.about.com/od/s/g/spondylosis.htm) Retrieved on 1 September 2012. • Spine-health.com. 2012. Spondylolysis Definition. (http://www.spine-health.com/glossary/s/spondylolysis) Retrieved on 3 September 2012. • Brooks KB, Southam SL, Mlady GW, Logan J and Rosett M. 2009. Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain. Skeletal Radiology (2010) 39:669-673.

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