Spondylolysis

Overview

What is spondylolysis?

Spondylolysis is a spine condition that can be painful. It's a problem with the connection between vertebrae — the bones that make up the spine. Having spondylolysis can lead to small stress fractures or cracks, often after repeated injuries during sports.

Spondylolysis is also known as a "pars defect" because it affects a tiny spinal bone called the pars interarticularis.

Is spondylolysis the same as spondylolisthesis?

Spondylolysis and spondylolisthesis are related but not the same.

  • Spondylolisthesis is when one vertebra slips out of place over the vertebra below.
  • Spondylolysis is a common cause of spondylolisthesis, because the crack in the vertebra may cause the bone to slip.

How common is spondylolysis?

Spondylolysis affects about 3% to 7% of Americans. It’s common in kids and teens, especially those who participate in sports such as gymnastics or football. Overstretching or overextending the spine, but not inflexion (bending inward) can lead to small cracks in the vertebrae.

Symptoms and Causes

What causes spondylolysis?

If you have spondylolysis, you typically have a weakness in a section of the vertebra called the pars interarticularis. This thin piece of bone connects the facet joints, which link the vertebrae directly above and below to form a working unit that permits movement of the spine. The cracks are often called pars fractures.

While we don’t know exactly why the weakness occurs, your genes might play a role. You may be born with thin vertebrae, which puts you at higher risk for pars fractures. Repetitive trauma to the lower back — for example, injuring yourself over and over through sports or other activities — can also weaken the pars interarticularis.

What are the symptoms of spondylolysis?

It’s possible to have spondylolysis and not even feel any symptoms. If you do experience symptoms, low back pain is the most common. The pain often:

  • Spreads across the lower back.
  • Feels like a muscle strain.
  • Is made worse with extension

Symptoms often appear during teen growth spurts. The typical age of diagnoses is 15 to 16 years (younger in females).

Diagnosis and Tests

How is spondylolysis diagnosed?

Your healthcare provider will ask you about your symptoms and medical history. You’ll probably also need some imaging tests.

What imaging tests might I need?

An X-ray of the lower back can show if there are any fractured vertebrae. You may also need CT or MRI scans to detect small fractures or rule out other spine conditions that could cause back pain, such as a herniated (bulging) disc or pinched nerve.

Management and Treatment

How is spondylolysis treated?

Healthcare providers typically use nonsurgical methods to treat spondylolysis. Your care might include activity modification medications and physical therapy. In rare cases, surgery is necessary.

What nonsurgical treatments are available for spondylolysis?

The goals of treatment are to reduce your pain, allow the fracture to heal and help you get back to your daily activities. You may need to follow the treatment regimen for a few weeks to a few months to feel complete relief.

Treatments include:

  • Rest: Take a break from sports and other strenuous activities.
  • Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin®) can help reduce pain and inflammation. Your healthcare provider may prescribe stronger medications as needed.
  • Steroid injections: Your healthcare provider injects steroid medication directly into the affected area to help relieve pain.
  • Physical therapy: A physical therapist helps you learn exercises to strengthen your muscles and improve flexibility, so you can move without pain.
  • Bracing: Occasionally, healthcare providers recommend a back brace to stabilize the spine as the pars fracture heals.

Do I need surgery for spondylolysis?

Surgery for spondylolysis is rare. Most of the time, people feel better through nonsurgical treatments.

Some people need surgery to stabilize the spine. A pars repair surgery fixes the pars fracture without needing to perform a spinal fusion (where surgeons fuse the two vertebrae together to form one bone).

In pars repair, surgeons remove scar tissue from the fracture area. They stabilize the sides of the fracture, often using a piece of bone from another part of the body. You will likely need rehabilitation after surgery to help you get back to full function.

Prevention

Can spondylolysis be prevented?

No, but you can take steps to reduce your risk of fractures. If you hurt your back or have low back pain that interferes with your life, see your healthcare provider. The earlier you start treatment, the better the outcome. You can also do exercises to strengthen your abdominal (belly) and back muscles, which will help support your lower back.

If you have spondylolysis, choose activities such as swimming and biking to reduce the risk of fractures. These exercises are gentler on your lower back.

Outlook / Prognosis

What can I expect if I have spondylolysis?

If you have spondylolysis, treatments such as rest, medication and exercise can relieve your pain. They work best if you seek care early. These treatments can't undo the fracture, but they can help you return to your daily activities without pain.

Are there complications of spondylolysis?

Without treatment, spondylolysis can lead to spondylolisthesis . In this condition, the fracture causes one of the vertebrae to slip out of place. If the vertebra presses on a nerve, you may have severe pain. In some cases, people need surgery to relieve spondylolisthesis symptoms and get back to full functioning.

The back pain that comes with spondylolysis can also lead to reduced mobility. As you move and exercise less, you may start to gain weight. You could also lose muscle mass and flexibility. Getting treatment and finding new activities can help.

When can I return to activities and sports?

Your healthcare provider will monitor your treatment progress. As you start to have less pain and more flexibility, you’ll be able to return to your regular activities. Typically, people need a few weeks to a few months of treatment to get rid of pain.

Living With

When should I see my doctor about back pain?

Treatment works best when it’s started earlier. See your healthcare provider as soon as possible if you injure your lower back or have back pain that interferes with your daily life.

What can I do to keep it from coming back or getting worse?

Strengthening exercises can help build strong back and stomach muscles (your core). Having good core strength can lower the risk of back injuries. You should also make regular appointments with your healthcare provider for follow-up.

A note from Cleveland Clinic

Spondylolysis can cause back pain that disrupts your daily activities. In most cases, rest, medication and physical therapy exercises relieve the pain without surgery. With proper care and treatment, you can return to an active life.

Last reviewed by a Cleveland Clinic medical professional on 08/07/2020.

References

  • American Academy of Orthopaedic Surgeons. Spondylolysis and Spondylolisthesis. Accessed 7/30/2020.
  • North American Spine Society. Spondylolysis and Spondylolisthesis. Accessed 7/30/2020.
  • Scoliosis Research Society. Spondylolysis. Accessed 7/30/2020.
  • Tay BB, Freedman BA, Rhee JM, Boden SD, Skinner HB. Chapter 4. Disorders, Diseases, and Injuries of the Spine. In: Skinner HB, McMahon PJ. eds. Current Diagnosis & Treatment in Orthopedics, 5e. New York, NY: McGraw-Hill; 2014. Accessed 7/30/2020.

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