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spondylolysis
A fracture or cleft in the vertebral body, often through the posterior vertebral arch, loosening its normally firm attachment to contiguous vertebrae.
Etiology:
1) recurrent microtrauma during excessive lumbar hyperextension
2) congenital
Epidemiology:
1) gymnasts, dancers, divers, weightlifters, football players (lineman), other sports activities
2) 50% of adolescent athletes evaluated for low back pain
3) also occurs in general population
4) Caucasions > blacks
5) male > female
Pathology:
- most often involves L5 vertibrae
Clinical manifestations:
1) low back pain, exacerbated by lumbar hyperextension
2) may be asymptomatic
3) unilateral pain localized to side of involvement
4) straight leg raising may be impaired on the side of involvement
5) forward bending may be impaired
6) hamstring tightness may be observed
Radiology:
1) X-ray of LS spine
2) bone scan may detect early fracture & distinguish old vs new fracture
Complications:
- progression to spondylolisthesis
Differential diagnosis:
- vertebral fracture
- trauma, osteoporosis, malignancy
- point tenderness
- vertebral disk injury
- pain radiating to lower extremity, paresthesias
- disc herniation visible on X-ray
- Schmorl modes
- older patients with degenerative disc disease (may be seen in younger patients)
- sacroiliitis: buttocks pain, morning stiffness
Management:
1) treatment is controversial
2) referral to orthopedic surgeon [1]
3) rest
4) lumbar brace to prevent hyperextension
5) indications for surgical fusion
a) intractable pain
b) growing child with slippage > 50%
Related
spondylitis
spondyloarthropathy (HLA B27-associated arthritis, seronegative spondyloarthropathy)
spondylolisthesis (listhesis, olisthesis)
spondylosis
General
sign/symptom
References
- UpToDate 14.1
http://www.utdol.com
Images
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