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Description
The most common X-ray identified cause of low back pain in
adolescent athletes is a stress fracture in one of the bones
(vertebrae) that make up the spinal column. Technically, this
condition is called spondylolysis (spon-dee-low-lye-sis). It
usually affects the fifth lumbar vertebra in the lower back, and
much less commonly, the fourth lumbar vertebra.
If the stress fracture weakens the bone so much that it is
unable to maintain its proper position, the vertebra can start
to shift out of place. This condition is called
spondylolisthesis (spon-dee-low-lis-thee-sis). If too much
slippage occurs, the bones may begin to press on nerves and
surgery may be necessary to correct the condition.
Risk Factors/Prevention
Genetics: There may be a hereditary aspect to
spondylolysis. An individual may be born with thin vertebral
bone and therefore be vulnerable to this condition. Significant
periods of rapid growth may encourage slippage.
Overuse: Some sports, such as gymnastics, weight
lifting and football, put a great deal of stress on the bones in
the lower back. They also require that the athlete constantly
over-stretch (hyperextend) the spine. In either case, the result
is a stress fracture on one or both sides of the vertebra.
Symptoms
- In many people, spondylolysis and spondylolisthesis are
present, but without any obvious symptoms.
- Pain usually spreads across the lower back, and may feel
like a muscle strain.
- Spondylolisthesis can cause spasms that stiffen the back
and tighten the hamstring muscles, resulting in changes to
posture and gait. If the slippage is significant, it may
begin to compress the nerves and narrow the spinal canal.
Diagnostic tests
X-rays of the lower back (lumbar) spine will show the
position of the vertebra.
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The pars interarticularis is a portion of
the lumbar spine. It joins together the upper and lower
joints. The pars is normal in the vast majority of
children.
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| If the pars “cracks” or fractures,
the condition is called spondylolysis. The X-ray
confirms the bony abnormality.
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If the fracture gap at the pars widens,
then the condition is called spondylolisthesis. Widening
of the gap leads to the fifth lumbar vertebra shifting.
It shifts forward on the part of the pelvic bone called
the sacrum. The doctor measures standing lateral spine
X-rays. This determines the amount of forward slippage.
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| If the vertebra is pressing on nerves, a
CT scan or MRI may be needed before treatment begins to
further assess the abnormality.
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Treatment Options
Initial treatment for spondylolysis is always conservative.
The individual should take a break from the activities until
symptoms go away, as they often do. Anti-inflammatory
medications such as ibuprofen may help reduce back pain.
Occasionally, a back brace and physical therapy may be
recommended. In most cases, activities can be resumed gradually
and there will be few complications or recurrences. Stretching
and strengthening exercises for the back and abnormal muscles
can help prevent future recurrences of pain.
Periodic X-rays will show whether the vertebra is continuing
to slip.
Treatment Options: Surgical
Surgery may be needed if slippage continues or if the back
pain does not respond to conservative treatment and begins to
interfere with activities of daily living. A spinal fusion is
performed between the lumbar vertebra and the sacrum. Sometimes,
an internal brace of screws and rods is used to hold together
the vertebra as the fusion heals.
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