Conditions & Treatments - Spondylolysis


Spondylolysis occurs as a result of a defect with resulting stress fractures of the pars interarticularis of the vertebra (1, 2, 3, 4, 5). It is found commonly at L5 and can occur not only unilaterally but bilaterally as well (2, 3). Over time it may progress to a spondylolisthesis (slipping of a vertebra on the vertebra below) (3, 4, 5). Spondylolysis affects about three to seven percent of Americans (1). It is considered an overuse injury and is a cause of low back pain found in young children and teens involved in sports which requires frequent extension and rotation of the spine ie. gymnastics, dance, baseball pitching, tennis, volleyball, football, weight lifting, etc. (1, 2, 3, 4, 5). Predisposing factors for spondylolysis includes: hyperlordosis, thoracic kyphosis, iliopsoas inflexibility, thoracolumbar facial tightness, abdominal weakness, female athlete triad (2).

Symptoms of Spondylolysis
Individuals with spondylolysis can sometimes by asymptomatic but often presents as focal low back pain which may be tender upon palpation over the site of the fracture (1, 4). Pain is usually made worse with vigorous activities and with activities which requires back extension (1, 2, 3, 4). Pain may also be reproduced by having the patient stand on one leg and hyperextending the lumbar spine (unilateral extension test or Micheli’s test) (4). The patient then repeats the move on the other side. If the test produces pain, this is indicative of active spondylolysis (4).


Diagnosis of Spondylolysis
Making an early diagnosis with a pars defect is important to help assess early stage pars defects that that are healing and resulting in bone re-union (5). Medical imaging can be utilized to help diagnosis spondylolysis. A radiograph can be performed but has low sensitivity (2). A single photon emission computed tomography (SPECT) scan can also be performed to allow for improved visibility but a positive SPECT needs to be followed up with a CT scan secondary to low specificity of a SPECT (2). A CT can help with identifying anatomical details of a pars defect but is not good at identifying an active vs. inactive fracture or early stress reaction (2). A combination of SPECT and CT can produce more detailed results (2). A SPECT allows for high sensitivity for bone activity, while CT allows for the highest anatomical specificity (2). A negative CT and a positive SPECT suggests a stress response, pre-lysis, early incomplete and good prognosis for healing and bone union (2). A positive CT and negative SPECT suggests a non union chronic lesion (2). A MRI is another imaging tool that can be utilized which is sensitive for early active lesions and visualization of other spinal disorders (2). However, it has lower sensitivity involving incomplete fractures and lacks ability to grade the lesion & detect bony healing (2).

Spondylosis can be subdivided in five categories: dysplastic, isthmic, degenerative, traumatic and pathological - each representing distinct considerations and characteristics for all healthcare providers (5):

Type of Spondylolysis Title Pathogenesis
Type I Dysplastic Congenital Abnormalities
Type II Isthmic Stress fractures in the pars interarticularis
Type III Degenerative Degeneration of the intervertebral discs
Type IV Traumatic Acute fractures in areas other than the pars
Type V Pathological Bone diseases, tumors, or infections


Spondylolysis Treatment Options for a PT (1, 2, 3, 4, 5)
• Rest, Removal From Sport
• Bracing
• Postural/Functional Training
• Stretching
• Strengthening/Core Stabilization
• Manual Therapy

Last revised: June 21, 2016
by Chai Rasavong, MPT, COMT, MBA


hic_Spondylolysis Last accessed 6/21/15
2) Last accessed 6/21/15
3) Last accessed 6/21/15
4) Last accessed 6/21/15
5) Last accessed 6/21/15

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