Spondylolysis

Spondylolysis is a condition that causes frequent low back pain in children because of a defect in the lumbar vertebrae. It is more common among children and teenagers who participate actively in sports such as football, weightlifting and gymnastics. This defect can cause stress fractures or breaks in the vertebrae that weaken the bone and lead to slippage, a condition referred to as spondylolisthesis

Symptoms

Although initially the patient may not have any symptoms, lower back pain may appear during the teenage growth spurt period. The pain becomes worse with vigorous physical activity and exercises. Sometimes, the pain may feel similar to a muscle strain.

Causes

Spondylolysis occurs as a result of a defect or stress fracture in the pars interarticularis, the part of the lumbar spine joining the upper and lower joints. Genetic factors may have a role. Children born with thin vertebra are prone to vertebral stress fractures. Also, repetitive trauma to the lower back area that occurs during sports and other activities can cause weakness  of the pars interarticularis ,resulting in spondylolysis.

Risk Factors

Risk factors for developing spondylolysis include:

Family history of back problems,

Repetitive trauma to the lower back,

Increased lordosis (swayback),

Incomplete development of spinal cord (spina bifida occulta), and Participation in sports such as football, gymnastics and weight lifting that require constant overstretch.

Complications

Untreated spondylolysis may lead to further complications including:

Spondylolisthesis, a condition where one or more vertebrae slips out of place

Limited mobility and inactivity

Weight gain because of inactivity

Loss of bone density

Loss of muscle strength

Loss of flexibility

Permanent nerve damage

Chronic back pain

Numbness, tingling or weakness in the legs

Nerve compression causing problems with bowel or bladder control

Diagnosis

Your physician will diagnose the condition based on the following factors:

Family History: As spondylolysis is  genetically related, family patterns are helpful to diagnose the condition.

Medical History: You will be asked about any related medical conditions of your child that could be contributing to the condition.

Physical Examination: The physical examination helps to identify and to rule out conditions with similar symptoms.

X‐ray: X‐ray of the spine is taken to look for defects or fractures.

CT scan or MRI scan: May be needed to detect very small fractures, and other conditions causing pain.

Treatment

Primary treatment for spondylolysis is always conservative. The goal of the conservative treatment is to reduce the pain, allow the fracture to heal and improve the function. Conservative treatment options include:

Rest

Medications

Physical therapy

Use of braces

Rest

Adequate rest should be taken and strenuous exercises should be avoided until the symptoms subside.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce the pain and inflammation.

If NSAIDs do not provide relief, epidural steroid injections may be administered to the spine to reduce pain, numbness and tingling in the legs.

Physical therapy

An exercise program helps to strengthen the abdominal and back muscles, improve flexibility and increase range of motion of the lower back.

Use of Braces

In severe cases of spondylolysis, a brace or back support may be used to stabilize the lower back during fracture healing.

Surgical treatment

Surgery is usually required if spondylolysis causes slippage of the vertebra, a condition called spondylolisthesis. The goal of the surgery is to remove any abnormal bone compressing a nerve and to stabilize the spine.

Decompressive laminectomy

This is a surgical procedure in which a portion of the bone or lamina causing pressure on the nerves is removed. A surgical incision is made in the back, then part of the bone and thickened tissue pressing on the spinal nerves is removed. This allows more space for the nerves thus relieving pain and pressure. This procedure makes the spine unstable therefore another procedure called a spinal fusion will also be performed to stabilize the spine.

Spinal Fusion

This is a surgical technique used to join together two bones in the spine. In spinal fusion, a piece of bone, taken from elsewhere in the body or donated from a bone bank, is transplanted between the adjacent vertebrae. As healing occurs, the transplanted bone fuses with the spine. This stimulates growth of a solid mass of bone which helps to stabilize the spine. In some cases, metal implants such as rods, hooks, wires, plates or screws are used to hold the vertebra firm until the new bone grows between them.

Prevention

Although spondylolysis is not completely preventable, certain factors can reduce the risk of developing the condition:

Maintaining a healthy weight to reduce stress on the lower back

Core exercises to keep the abdominal and back muscles strong will help to support the lower back

Eating a well balanced diet to keep your bones strong

Risks and complications

Although surgical treatments treat spondylolysis they are associated with certain risks and complications. These can include:

Failure to relieve back pain or failure of surgery

Dislocation of grafts or implants used

Nerve damage

Infections

Blood clots

As spondylolysis may cause serious complications in the future, parents should pay attention to children when they complain about pain or stiffness in the neck or back. Immediate medical intervention may have a better outcome and avoid future complications.