INJURY OF THE MONTH

Spondylolysis

Spondylolysis is a degeneration of the vertebrae and most commonly a defect in the pars interarticularis of the articular processes. 

 

The condition is attributed to a congenital weakness and occurs as a stress fracture.  It is more common in males than females.  Acute mechanism of injury is either sudden or repetitive hyperextension of the spine. 

 

This hyperextension causes compression of the articular processes of the vertebrae.Spondylolysis begins unilaterally, however, once the fracture results in slipping of on vertebrae onto another, the condition develops into spondylolisthesis. 

 

Due to the slipping of vertebrae, a step deformity is visible on the patient’s back.  With spondylolisthesis, the highest incidence of vertebral slipping is between the L5 and S1 vertebrae.  Although spondylolysis is more common in males, spondylolisthesis is more common in female.An individual with spondylolisthesis will usually have lumbar hyperlordosis postural impairment. 

 

Spondylolisthesis is easily detectable on an X-ray.The most common sign and symptom is persistent aching back pain and stiffness with increased pain after, but usually not during, physical activity.  The patient will feel the need to change positions frequently, or the desire to “pop” their back.  Truck movements are usually full ranges and painless with some hesitation with forward truck flexion.  The patient may fell weakness when extending from a forward flexed position.  There maybe tenderness with palpation and there might be hypermobility when applying posteroanterior pressure.  Finally, if vertebral displacement is significant enough, there may be neurological signs

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Bracing and bed rest for several days should reduce pain.  The major goals of rehab should be to control or stabilize the hypermobile vertebral segment.  Truck strengthening and core stabilization should be used.  Braces are most helpful during high-level activity, but because of hypermobility of lumbar vertebra, it may be necessary for the athlete to avoid vigorous activity.