The Basics of Back Pain With Spondylolysis

Spondylolysis is a term that refers to a fracture of one of the vertebral bodies in the spinal column. The first part of the word “spondylo” means spine, and the second part of the word “lysis” means fracture. The question of who gets spondylolysis is one of a repetitive trauma to the vertebral body that results in a stress fracture. The repetitive trauma to the vertebral body comes from activities that involve hyperextension. An example of this activity would be a football lineman who over and over again moves from a position where he’s on all fours up to a hyperextended position with his back in order to defend the football line. Additional activities that often end up with a spondylolysis include cheerleading, gymnastics, and rowers. The typical age range for spondylolysis occurring includes the teenage years and moving into college age individuals.

The diagnosis is made from a combination of:

  • Physical examination and history
  • Imaging studies such as x-rays and MRIs or maybe a CAT scan.
  • Potentially a bone scan

It may be necessary to obtain a bone scan (dexa scan) as the exam and imaging studies may not definitively show the fracture. There is one particular view that is an oblique x-ray of the lumbar spine that is the best for seeing the fracture. The finding of where the fracture is seen is referred to as the “Scotty Dog” view and one can see a line across the “neck of the Scotty Dog” which is the anatomical area known as the pars interarticularis.

In order to see if the spondylolysis is actively trying to heal the bone scan may help there too. If it lights up on a bone scan the you know that the patient’s bone is actively trying to heal itself. The area that is undergoing a stress fracture is called the pars interarticularis.

Treatment for spondylolysis involves activity restrictions and bracing. If the patient is a football player football should be restricted for a time period to allow the fracture the ability to heal. This can be very difficult for players who are attempting to become high level athletes that are restricted by the pain from the spondylolysis.

On top of that now you tell that patient not to compete in his or her chosen field of expertise. So compliance can be difficult in this population. In addition to activity restrictions and lumbar bracing, the patient may be given anti-inflammatory medication along with Tylenol in order to alleviate his or her pain.

One of the ways to see if the fracture has healed is first and foremost if the patient’s pain is alleviated, but also the bone scan can be repeated see if it no longer “lights up”. If the fracture has healed, there will be no uptake into the fracture area of the injected material as it attaches to bone that is healing only.

Unfortunately there’s no guarantee that the spondylolysis fracture pain will not come back even if treatment is successful the first time. Therefore it is necessary to be aware that the pain may come back and not to go back too soon to the high level activities but to gradually work one’s way back up into those levels.

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