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Table of Contents
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.
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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.
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Symptoms
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In many people, spondylolysis and
spondylolisthesis are present, but
without any obvious symptoms.
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Pain usually spreads across the
lower back, and may feel like a
muscle strain.
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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.
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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.
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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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