Spondylolysis

The most frequent abnormalities are: Lumbosacral transitional anomalies Scoliosis Hyperyphosis Hyperlordosis Rectification Spondylolysis Spondylolisthesis Vertebral arthritis Facet arthritis Spinal stenosis Fissure, protrusion and disc herniation Postoperative fibrosis Dislocation of the coccyx Atlantoaxial Dislocation Sprain Whiplash Syndrome

What it is

This means breaking of the vertebral lamina so that the facet joint is separated from the rest. The vertebra most commonly affected is the fifth lumbar, followed by the fourth lumbar vertebra. In most cases where spondylolysis affects the fourth lumbar vertebra there is sacralization of the fifth lumbar vertebra.

How it takes place

In most cases this is not a true break, but rather that the bone fails to form completely. In such cases the separation between the facet joint and the rest of the lamina is present from birth and remains present throughout the subject's life.

In other cases where the bone is fully formed, the vertebral lamina breaks as a result of repeated falls or traumatisms. This typically occurs in sportsmen and women, and spontaneous repair normally takes from 6 to 9 months.

Symptoms

Spondylolysis frequently causes no pain or other symptoms and simply turns up by chance on an X-ray. This is specially true of spondylolysis that occurs as a consequence of defective bone formation.

Cases of spondylolysis due to repeated fracture or traumatism can cause pain in the vertebral zone.

Where spondylolysis is demonstrated in a patient with low back pain, this does not necessarily mean that it is the cause of the pain. In fact it is only considered to be the cause of the pain when due to a recent fracture.

Risk

When spondylolysis occurs on both sides (left and right), the vertebra may slip forward or backward, giving rise to spondylolisthesis.

However, this does not always occur and spondylolysis is frequently observed in healthy subjects who feel no pain or discomfort.

Diagnosis

To diagnose spondylolysis, an X-ray is required.

In a few cases, it may also be worth doing radionuclide imaging of the bone to:

1. Confirm the existence of spondylolysis where the X-ray image is not clear, or it is advisable to rule out general diseases (such as infections or tumors).
2. Distinguish spondylolysis caused by poor bone formation (in which case radionuclide imaging would be standard) from spondylolysis caused by a fracture, although even in the latter case the radionuclide imaging will only show a conclusive image in the first seven days.
3. Monitor the progress of healing of the bone in spondylolysis caused by repeated fracture or traumatism in sportsmen or women. This can help to establish the earliest time that they can resume training.

Treatment

In cases where spondylolysis is due to a defect of bone formation and there is no associated spondylolisthesis, no action is needed. In such cases the spondylolysis is not a disease but simply a chance find.

In cases where spondylolysis is due to breaking of the bone through repeated fracture or traumtism, it is advisable to reduce or suspend physical effort until the patient has recovered, including the intensive training sessions of sportsmen and women.

A corset may be indicated for patients whose spondylolysis is due to bone fracture (and not poor formation), when the pain persists in spite of reduced activity and treatment.. In such cases, action must be taken to prevent muscular atrophy and the corset must be removed for progressively longer periods and completely removed as early as possible.

Surgery is only indicated when:

1. The pain persists despite treatment for a period of 9 months, and
2. It is demonstrably a case of spondylolysis due to bone fracture and shows no sign of mending after 9 months.

In such cases arthrodesis is indicated, but only on the segment where the spondylolysis is located, normally between the fifth lumbar and the first sacral vertebra.