Spondylolysis is an overuse injury in which there is a repeated stress to an area of the vertebral column called the pars. This causes a stress fracture.
Spondylolysis And The Spinal Column
Vertebrae makes up the spinal column, and interposing discs are mounted atop each other. The pars interarticularis also called the pars in an obscure area of the vertebra in the region of the facet. High amounts of compressive load is often exerted in the area. It is small is a weak link in the vertebrae that, It has been proposed that this region is particularly vulnerable when the spine is in an extended position and force suddenly compresses through the spinal column, such as landing on the foot after a hop. It occurs most commonly at the fifth lumbar vertebrae, which is the last mobile segment in the spinal column. However it may occur at any of the other lumbar as well as thoracic vertebrae.
Spondylolysis affects 4-6% of the population. It is especially common in adolescents who engage in competitive sports. This leads to an over training of certain biomechanics imposing repetitive stress. The various sports where this is a common occurrence are gymnastics, dance, tennis and cricket. The spine is bent forward, bent back, and rotated many times in these sports. This creates a mechanical stress. While spondylolysis is much more common in youths, it can occur in the general population too.
Obesity and ageing are two strongly associated factors with its incidence in the general population. Obesity causes an increase in the natural curve of the lumbar spine, i.e. lordosis. This leads to increased stress and load on the spine. Aging on the other hand causes loss of bone density which can lead to a stress fracture. Spondylolysis also runs in families. It is more prevalent in some populations; suggesting a hereditary component.
Symptoms Of Spondylolysis
Symptoms of spondylolysis include back pain. Activities involving hyperextension (excessive backward bending) exacerbates it. People often have tightness in the hamstring; created by the body to guard the back. Spondylolysis often leads to spondylolisthesis – a forward slipping of the vertebral body. This is because the attachment to the posterior elements of the vertebra is defected. This is a more serious condition as the instability has a possibility of a nerve compression.
Oblique lumbar spine X-rays helps to diagnose spondylolysis. An oblique x-ray of the lumbar spine shows what appears to be a “scotty dog”. It is in the area of the dog’s collar that the fracture occurs. CT scans and MRI can diagnose the condition too.
An early diagnosis is the key to treatment for spondylolysis as temporarily stopping the sporting activity is necessary for the bone to heal. In most cases this is a period of 4-6 weeks during which conservative treatment in the form of wearing a brace and physiotherapy are imperative. Physiotherapy treatment includes use of modalities to reduce the pain and more importantly spinal stabilization exercises for the core and pelvic floor muscles. Additionally motor control training to reduce postural lordosis and hyperextension during dynamic activities such as sports ensures correct biomechanics without imposing undue stress to the area in the future.
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