The most common finding on physical examination is low back pain and pain with extension of the lumbar spine (Figure 4). The bone scan can also be useful in differentiating an acute stress reaction (spondylolysis) from a chronic defect. Computerized Tomography (CT), and an MRI scan can be used to assess for a possible spondylolysis (Figure 5A &B). Standing PA, LAT, and Oblique x-rays of the lumbar spine are often obtained to evaluate for possible spondylolysis or spondylolisthesis (Figure 4A &B). The diagnosis of spondylolysis is made based on your child's symptoms, physical examination, as well as radiographs (x-rays) of the spine. How Are Spondylolysis & Spondylolisthesis Diagnosed? Certain racial groups, such as Inuits, have a much greater overall incidence (approximately 40%) of spondylolysis suggesting inherent genetic weakness of the pars. It is believed that the repetitive trauma can weaken the pars interarticularis and lead to a spondylolysis.Īnother theory is that genetics plays a role in the development of the pars defects and spondylolisthesis. These sports include gymnastics, diving, wrestling, weight lifting, and football linemen (Figure 3 A-C). For example, spondylolysis is much more common in individuals participating in sports that require frequent or persistent hyperextension of the lumbar spine. The exact cause of spondylolysis is unknown, although certain risk factors have been identified. There is an overall incidence of 5-6% in the general population, however only 10-15% of those individuals will develop symptoms. Many people with spondylolysis have no symptoms and do not even know that they have the condition. Approximately 85-90% of cases of spondylolysis occur at the L5 vertebral level. The spondylolisthesis is often classified on the degree of the slip with Grade I: 0-25%, Grade II: 25- 50%, Grade III: 50-75%, Grade IV: 75-100%, and Grade V: greater than 100% slippage. The slippage is much more common in individuals with bilateral spondylolysis and those with mechanical instability. Spondylolisthesis or slippage occurs in about 30% of patients with a spondylolysis. The defect in the pars interarticularis may allow anterior (forward) displacement or slippage of the vertebrae which is called spondylolisthesis (Figure 2). The pars interarticularis is the part of the vertebrae between the superior and inferior facets (Figure 1). A spondylolysis in a child or adolescent most commonly results from a defect or stress fracture in the pars interarticularis of the vertebrae. Spondylolysis is classified as dysplasic (congenital), isthmic (stress fracture), degenerative, or traumatic. Spondylolysis and spondylolisthesis are the most common causes of structural back pain in children and adolescents. The most common surgical procedures used in treating spondylolysis and spondylolisthesis are direct repair of the defect and/or posterior instrumented spinal arthrodesis (fusion). If extensive non-surgical therapies/treatment fails to improve symptoms, there are several surgical options available.Spondylolysis and spondylolisthesis are treated symptomatically (no pain=no treatment necessary (except in cases with severe slips which may require surgical correction/arthrodesis).Treatment is generally conservative and consists of activity modification, rest from sports/activities, use of a Boston Overlap lumbar brace, physical therapy, pain medication, bone stimulator and/or injections to relieve pain.Hamstring tightness is commonly associated with spondylolysis.Spondylolysis is a common cause of low back pain in adolescent athletes.Billing, Insurance & Financial Assistance.
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