• About Us
  • Centers of Excellence
  • How to Choose a Doctor
  • Tour the Clinic
  • In the News
  • Testimonials
  • For Physicians
• Our Physicians
  • Spine Surgeons
    • Dr. Matthew Geck
    • Dr. Jason Lowenstein
    • Dr. Kurt Von Rueden
  • Nonsurgical Care
    • Dr. Eduardo Elizondo
    • Dr. David Harris
    • Dr. Lee Moroz
• Spine Problems
  • Back Pain
  • Neck Pain
  • Degenerative Disc
  • Herniated Disc
  • Bone Spur
  • Stenosis
  • Scoliosis
  • Kyphosis
  • Spondylolysis
  • Spinal Tumor
• Treatment
  • Home Remedies
  • Nonsurgical Care
  • PMR Physicians
  • Physical Therapy
  • Injection Therapy
  • Surgical Options
    • Artificial Disc
    • Minimally Invasive
  • Post Surgical Care
• Educational Resources
  • Symptoms Chart
  • Anatomy Library
  • Exercise Library
    • Back Exercises
    • Neck Exercises
    • Strengthening
  • Preventing Back Pain
  • How to Lift
• Clinical Outcomes
  • Our Report Card
• Contact Us
  • Make an Appointment
  • Registration Forms
  • Second Opinion
  • Physician Referrals
•  

Home >> Spine Problems >> Spondylolysis

Spondylolysis

Spondylolisthesis and spondylolysis are caused by joint instability in the low back. When a person experiences low back pain that does not subside after a few weeks, a spine doctor will scan for this instability by taking X-rays or performing other diagnostic tests.

Overview

The instability of specific bones in the low back can be attributed to spondylolysis. This is a very common cause of back pain, particularly in adolescents. Gymnasts who perform routines that bend and arch the back are often victims of spondylolysis or spondylolisthesis. If left untreated, spondylolysis can lead to spondylolisthesis. Many victims of spondylolisthesis do not experience symptoms and may not know they have it.

select image to enlarge Spondylolysis diagram

select image to enlarge Spondylolisthesis diagram

Causes

Spondylolisthesis and spondylolysis are caused by joint instability in the low back. The rear part of spinal vertebrae has facet joints that act as hinges, allowing our spines to twist and bend. Sometimes, however, the posterior element can crack. Either from heredity or wear and tear, part of the posterior element called the pars interarticularis can crack, causing the vertebrae slip forward out of its correct position. Spondylolysis occurs when the PARS hinge is cracked, but the vertebrae is still in its correct position. Spondylolisthesis occurs when the cracked PARS has allowed the vertebrae to slide forward out of its correct position. If left untreated, spondylolysis can lead to spondylolisthesis.

Symptoms

Interestingly, in many cases, spondylolisthesis may have no symptoms, so most people may not know they have it. Back pain is the most common symptom, particularly in the lower back. This back pain may be mistaken for a muscle strain. Muscle spasms that occur as a result of spondylolysis may cause an overall feeling of stiffness in the back and may effect posture.

Diagnosis

Outlined below are some of the diagnostic tools that your physician may use to gain insight into your condition and determine the best treatment plan for your condition.

Medical history:

Performing a detailed medical history allows the doctor improved understanding of the possible causes of your back and neck pain. Moreover, this knowledge may help outline the most appropriate treatment.

Physical exam:

The physical exam is helpful in allowing your physician to isolate the source of pain. Simple tests for flexibility and muscle strength may also be conducted.
X-rays are usually the initial step in diagnostic testing methods. While x-rays show bones and the space between bones, they are of limited value because they do not show muscles and ligaments.

MRI (magnetic resonance imaging):

Involves magnetic field and radio waves to produce highly detailed pictures of the inside of your body. As x-rays only show bones, MRIs are necessary to envision soft tissues like discs in the spine. This type of imaging is very safe and usually pain-free.

CT scan/myelogram:

Comparable to an MRI, a CT scan provides diagnostic information about the internal structures of the spine. A myelogram is engaged to diagnose a bulging disc, tumor, or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into the low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems exist.

Electrodiagnostics:

As part of a diagnostic workup, electrical testing of the nerves and spinal cord may be performed. These tests, called electromyography (EMG) or somato sensory evoked potentials (SSEP), help your doctor understand how your nerves or spinal cord are affected by your condition.

Bone scan:

In an effort to detect infection, malignancy, fractures and arthritis in any part of the skeleton, bone imaging is used. Bone scans are also helpful in locating lesions for biopsy or excision.

Discography:

Used to determine the internal structure of a disc. It is performed via local anesthetic and by injecting a dye into the disc under X-ray guidance. Both X-ray and CT scan are performed to establish whether disc composition is normal or abnormal. Additionally, your doctor will note any pain associated with this injection. The benefit of a discography is that it enables the physician to verify the disc level that is causing your pain. This exam helps reduces the risk of operating on the wrong disc as well as ensures surgery will be more successful.

Injections:

Pain-relieving injections help relieve back pain and give the physician important information about your problem, as well as provide a bridge therapy.

Treatment

Moderate treatments should always be considered first when treating spondylolysis. Nonsurgical treatment methods include resting and refraining from usual activities, taking anti-inflammatory medication, and incorporating a stretching and strengthening program. While ligaments and muscles can help hold the vertebrae in place, over time, surgery may be necessary to install surgical instrumentation or bone grafts that lock the vertebra in place so that it does not slide out of position and damage the spinal nerves. Surgery may involve a fusion and/or screws and rods.

FAQ

How do I know if I am at risk for spondylolysis?

• Those with a family history of spondylolysis or weak vertebrae are more susceptible to developing the condition. Also, athletes involved in activities that place a great deal of stress on the back, such as football players and weight lifters, are at greater risk for fracturing the vertebrae, encouraging slippage.