In these cases, surgical options usually include lumbar spinal fusion or direct repair of the fracture. This usually occurs when one or more vertebrae slip out of place relative to one other ( spondylolisthesis) or if there is persistent back pain. In some instances, however, there may be persistent symptoms that necessitate surgical intervention. When do I need surgery for spondylolysis?įortunately, the symptoms of spondylolysis almost always respond favorably to physical therapy and activity modification. If the patient has persistent pain after nonsurgical treatment, surgery may be required. The fracture can be assessed with a series of X-rays every few months. Treatment is individualized depending on the injury, age and the demands of the sport. The initial treatment for these types of stress fractures is rest from activity and bracing, followed by physical therapy. A CT scan may be used to evaluate a pars defect and to visualize healing bone, while an MRI may be useful to assess the surrounding tissue and condition of the disc. tingling, numbness and/or stiffness in the backĮvaluation for this condition includes a review of the patient’s medical history and a physical exam, followed by X-rays, which can detect a pars fracture.pain in the back, neck, legs, thighs or shoulder.a “pins and needles” sensation in a leg, with or without numbness or weakness in the leg. Occasionally, nerve symptoms can be present. Hyperextension (abnormal stretching) of the lower back will usually aggravate the area as it overloads the pars fracture. What are the symptoms of spondylolysis?Ī person with a pars defect may feel pain and stiffness in the lower back that is worsened with activity and improves with rest. When fractures occur on both sides, it is possible for one vertebra to translate or move forward or backward over the neighboring vertebra. The crack may affect only one side, but it is not uncommon to have fractures on both sides of the vertebra. However, an injury can occur too quickly for the vertebra to be repaired, and this leads to a crack in the pars. The vertebra initially responds to increased physical strain of such activity by gradually adding new bone cells around the stressed area of the spine. Illustration of cross-section of spine, dorsal (back to front) and lateral (side) views, showing its vertebral sections. In football players, it is especially common in offensive and defensive linemen. It is also common in soccer, lacrosse and basketball players. In athletes, this type of injury can be seen when the back is bent backwards repeatedly, in activities such as gymnastics, karate and other martial arts. Pars fractures most commonly occur in the lowest lumbar vertebra (L5) of the lower back (lumbar spine). Where in the spine is spondylolysis most common? Active kids and teens with spondylolysis may experience symptoms, however, some people with this condition may not develop symptoms until later in adulthood. Spondylolysis is a common condition of children and teenagers who are involved in organized sports. Spondylolysis is the most common cause of structural back pain in children and teenagers. These stress fractures in the back are most often seen in adolescent athletes such as gymnasts, where there is a great deal of extension and landing with an arched back. In other words, it is usually a stress fracture rather than a sudden break. Spondylolysis usually occurs during childhood or adolescence from repetitive stress, rather than from an acute injury. Figure 2: Top view of spinal column What causes spondylolysis?
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