What Is Spondylolysis?

(Spon-dee-low-lye-sis) is a condition caused by stress fractures in part of the bones called vertebrae, which make up the spinal column.

Introduction

Spondylolysis is defined as a bony defect within the pars interarticularis of the vertebral arch. It can happen when the lumbar spine is repeatedly stretched and rotated, putting stress on the pars interarticularis.¹ In sports like gymnastics, football, weightlifting, wrestling, dance, and soccer, the lower back is often forced to bend forward and rotate at the same time.² Rather than happening in response to a single traumatic event, a stress fracture of the pars interarticularis happens in response to repetitive biomechanical loading.³ Teenage athletes are especially at risk because their spines are still growing.⁴

Genetics also play a part, as some genes can change the shape and mass of bones, which in turn changes how stress is distributed in the spine.²¹ A person is more likely to have spondylolysis if they have a family history of it.⁵ There may also be racial factors, as the condition is more common in Inuit communities (indigenous communities of Arctic and subarctic regions).⁶ Spina bifida occulta also makes the neural arch parts of the spine naturally weak, which can increase the risk of spondylolysis.⁷ 

Other risk factors include not having strong core muscles, overtraining, or not being fit enough, and using the wrong method when lifting weights.⁸ In the same way, not getting enough rest between sports seasons keeps people away from healing and recovering properly. 

In terms of age and gender, the highest incidence in people assigned male at birth (PAMAB) is seen between the ages of 15 and 17, while the highest incidence in people assigned female at birth (PAFAB) is seen between the ages of 35 and 45.⁶ 

Signs and symptoms

Signs and symptoms of spondylolysis are:

• Can be an acute or gradual onset of pain
• Localised pain in the lower back, usually one-sided^3,10
• Pain increases with back extension or rotation
• Pain worsens with activity.¹
• Muscle spasms in the lower back¹⁰
• Low back stiffness and reduced range of motion¹⁰
• Tight hamstrings¹⁰
• Occasionally, pain can radiate to the high, thigh, or groin but rarely goes lower than the knee⁴
• Rest usually eases the pain

Diagnosis

A full medical history and physical check of the lower back are the first steps in diagnosing spondylolysis. Patients are asked about where and what kind of back pain they have, what activities make it worse, any family history of the condition, and when the symptoms started.¹ The main goals of the physical test are to check the lumbar range of motion, localised tenderness, muscle spasms, and neurological function (including strength and sensation). Some tests, like the single-leg hyperextension test, are used to reproduce your pain. Imaging tests are needed to confirm the diagnosis after the first suspicion.

Plain X-rays are the first choice for imaging, and side views are the best way to see pars defects.12 However, images are not sensitive early on, before clear fractures show up. If the first pictures aren't clear but the doctor is very sure it's a problem, a CT or MRI scan is ordered to get a better look at the bones and soft tissues around the neural arch.⁴ MRI can also find early signs of bone marrow oedema at sites of stress reactions. CT scans are the best way to diagnose spondylolysis and rate the severity of the pars defec.¹³

SPECT bone scintigraphy is also very good at finding early stress reactions in bones before they break, which helps with the first steps of treatment. Scans can assist with a differential diagnosis between spondylolysis and other back pain conditions in young athletes, like disc disease or scoliosis.

Treatment

Most cases of spondylolysis can be treated safely with non-invasive methods, especially when caught early in teen athletes.¹ The basis is changing the person's activities to stop hyperextension sports that make the pars defect worse. This rests the area so that it can heal itself. As part of physical therapy, you may be prescribed exercises such as:¹⁴

• Strengthening of core, pelvic floor, gluteal muscles, spinal stabilisers and extensors
• Stretching of hip flexors and hamstrings
• Sport-specific exercises are to load the spine gradually in functional movements once initial core strengthening has been conducted.

Pain and swelling can be controlled with NSAIDs and other anti-inflammatory drugs while the spondylolytic injury heals. Using a rigid lumbar orthosis as a brace also gives support from the outside and reduces painful movement. So as not to lose muscle tone, bracing shouldn't be used in the long term.¹⁵ 

If there is no improvement after three to six months of non-invasive pain relief methods, specific epidural steroid injections may be tried.¹⁶ Surgery is only done for people with high-grade spondylolisthesis (where the vertebra slips forward) or mental decline who have tried other treatments and failed. Young players do well with pars repair, which is the direct repair of the stress fracture.¹⁷ 

Prevention

Athletes under 18 can avoid getting spondylolysis by taking several precautions. As strong core muscles keep the spine stable, it's important to do exercises to strengthen the core.¹⁸ This includes developing the lower back and glutes, as well as the abdominal muscles, so the lower back can support the body while it's moving. It's also important to keep your hamstrings as flexible as possible by stretching them.¹⁰

To keep from overextending the lower back, it's important to use the right method when lifting weights. A training belt can help you out even more. Coaches should show athletes how to use their bodies correctly and watch for signs of bad form while they train.¹⁹ Bones and tissues can heal and adapt to stresses if they get enough rest between sports seasons or when they do different high-impact activities.⁸ 

Being physically fit, having good muscle balance, and having healthy bones all make the spine stronger. Bone mineral density is improved by getting enough calcium and vitamin D in your diet. If you notice and fix muscle issues or problems with your posture right away, you can keep the asymmetry from getting worse. 

People who are at risk for acute pars injuries should avoid or limit sports that require violent hyperextension until the pain goes away. Increasing awareness and actively limiting spine extension during daily activities may also help reduce movements that cause pain.

Summary  

A stress fracture of the vertebral pars interarticularis is called spondylolysis. It's a common reason why busy teens have back pain. If you do sports like gymnastics or football, where you repeatedly hyperextend and rotate your lower back, you may develop a stress fracture. This is especially true if you already have a family history of fractures or spina bifida occulta. One of the symptoms is worsening one-sided lower back pain that is caused by tasks that involve extension. It is important to have early clinical suspect and diagnostic imaging since plain films may miss early lesions that don't turn out to be fractures.

Changing the activities you do, physical treatment focusing on strengthening your core, bracing, and painkillers that reduce inflammation usually help people get better. More coaches and trainers know about back pain in young players, which supports early intervention to stop the long-term effects of spondylolysis that aren't treated.