SPONDYLOLYSIS

Definition
 Spondylolysis is defined as the breakdown or fracture in a
specific region of the spinal column, called pars interarticularis.
The terms term comes from "spondylo," which means spine,
and "lysis," which means to divide.
 Pars interarticularis is a narrow bridge between the upper and
lower facets which connects the inferior articulating process to
the superior articulating process of the adjacent vertebrae in
the spine.
 It can occur on unilateral or bilateral and at any level of the
spine but most often at the fourth or fifth lumbar vertebra.
 If spondylolysis is present, then you have the potential to
develop spondylolisthesis.
 PATHOPHYSIOLOGY
o Pars interarticularis is the weakest structure in any type of lumbar motion and
L5 is the vertebra subjected to the greatest amount of static and dynamic stress.
o Higher stresses were found during extension and rotation at the ventral aspect
in all loading modes.
o The pars interarticularis is vulnerable to fracture during spinal hyperextension,
especially when combined with rotation, or when experiencing a force during a
landing. This stress fracture most commonly occurs where the concave lumbar
spine transitions to the convex sacrum (L5-S1).

Two main mechanisms involved:

 When the lumbar spine extends, the inferior articular process of the cranial
vertebra impacts the pars interarticularis of the caudal vertebra. Repetitive
impacts can produce a stress or fatigue fracture of the pars interarticularis.
 The pars interarticularis fails in tension through a traction mechanism.
Syrmou, et al. 2010.
Clinical Features
 Onset of pain is gradual or acute (after
intense athletic activity)
 Intense pain restricts activities of daily
living or sporting performance
 Symptoms become aggravated after a
stressful event
 Rest usually relieves the symptoms
 Symptoms for lumbar spondylolysis
 Focal low back pain with radiation into the buttock or proximal
lower limb
 Pain throughout lumbar range of movement
 Symptoms increase with movement (lumbar extension or rotation)
 Forward flexion does not increase symptoms
 No tenderness, but some discomfort can be elicited with deep
percussion over the midline of the lumbar area (children under 13
years old show tenderness)
 Children can present a postural deformity or abnormal gait pattern
 Sciatica can occur but rare
Causes
 Weakness in a section of the vertebra
 Genetics
 Repetitive trauma to the lower back
Complications
 Spondylolisthesis
 Permanent nerve damage
 Numbness or tingling or weakness in the
legs
Treatment Of Spondylolysis
 Rest (0-8 weeks).

 NSAIDS.

 Analgesics.

 Rarely surgery – in case of spinal cord

involvement.
Physiotherapy Treatment Of Spondylolysis
 Pain – Modalities (Cold/Heat) to promote healing and reduce muscle spasm.

 Gentle active range of movement exercises to relieve stiffness and keep your back moving
normally while you are still healing.

 Core stability and Strengthening the abdominal and back extensor muscles once pain free
range of movement has been achieved such as bridging, lunges, side plank, cat and camel,
aerobic exercises and etc.

 Stretching exercises for the hamstring and gluteal muscles.

 Sport specific exercises.

 Lumbar corset – with set of exercises.

Reference
 Cleveland Clinic, 2014, Spondylolysis, [online]
Available at:
<https://my.clevelandclinic.org/health/diseases/103
03-spondylolysis>[Accessed at 8 April 2019]
 Syrmou, E., Tsitsopoulos, P. P., Marinopoulos, D.,
Tsonidis, C., Anagnostopoulos, I., & Tsitsopoulos, P.
D. (2010). Spondylolysis: a review and reappraisal.
Hippokratia, 14(1), 17–21.