Spondylolysis (Lumbar)

Spondylolysis is a defect that occurs in the posterior part of the spine known as the pars intrarticularis.

Symptoms

Back and leg pain.

About this Condition

Spondylolysis is a defect that occurs in the posterior part of the spine known as the pars intrarticularis. There are many causes of spondylolysis. Spondylolysis usually occurs in young athletes. This disorder is essentially a stress fracture of part of the spine. When occurring at younger ages, it is often a source of lower back pain. Interestingly, this defect will also show up in adults with back pain and no prior history of injury or sports participation. Some adults are found to have a spondylolysis who have no symptoms whatsoever.

 

 

Spondylolysis is seldom seen in patients under the age of five and is found in five percent of people over the age of seven. Whether there is a hereditary component of the disease is not clear, but an explanation for the increase in instances relative to age could be explained by the increase in activity of children, as they get older. Young children involved in regular sports are more at risk of developing structural disorders including spondylolysis. Spondylolysis is a common cause of back pain in children, and the most likely cause of pain in patients under age 26, but rarely the only cause of complaints after age 40. *

Spondylolysis becomes a problem if it is painful or associated with instability of the spine. In these situations, it may be associated with lumbar disc degeneration of narrowing of the area where the nerve roots exit the spinal column (the neural foramina). This may be a cause of back and leg pain.

*Borenstein DG, Wiesel SW, Boden SD. Low Back Pain: Medical Diagnosis and Comprehensive Management. Philadelphia: Saunders; 1995.

[Source: Medtronic]

This content is for your general education only. See your doctor for a professional diagnosis and to discuss an appropriate treatment plan.

Conservative Treatments

Medication and Pain Management

The goal when prescribing medications should be maximum reduction of pain and discomfort with minimal risk of overuse of the medications and avoiding side effects.

Non-steroidal anti-inflammatory medications (NSAIDs) include common over-the-counter drugs such as aspirin, ibuprofen and naproxen among others. These drugs are potent long-term pain reducers that work without concerns of dependence.

Opioid therapy to control chronic back pain is less ideal because of potential toxicity to the body and physical and psychological dependence. Treatment by this class of drugs should generally be a short term option when patients do not respond to alternatives.

Pain can often be reduced through the use of muscle relaxants, anti-seizure pain medications such as Neurontin, Topamax, and Lyrica, anti-depressants, and oral steroids.

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Physical Therapy / Occupational Therapy

Physical and occupational therapy can play a vital role in your recovery. Once acute pain improves, your doctor or a therapist can design a rehabilitation program to help prevent recurrent injuries.

These programs often include heat, cold and electrotherapy to help alleviate pain, decrease swelling, increase strength and promote healing. Methods include therapeutic exercise, manual therapy, functional training and use of assistive devices and adaptive equipment to increase strength, range of motion, endurance, wound healing and functional independence.

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Injections

In some cases, your doctor may give you an injection of a corticosteroid to help relieve your pain and reduce inflammation. Corticosteroids mimic the effects of the hormones cortisone and hydrocortisone, which are made by the outer layer (cortex) of your adrenal glands. When prescribed in doses that exceed your natural levels, corticosteroids suppress inflammation, which in turn relieves pressure and pain. They are most effective when used in conjunction with a rehabilitation program. In addition, corticosteroids can cause serious side effects, so the number of injections you can receive is limited—usually no more than three in one year.

A steroid is often combined with an anesthetic and injected into the area around the irritated spinal nerves that are causing the pain. This area is called the epidural space, and it surrounds the sheath-like protective membrane, or dura, that covers the spinal nerves and nerve roots. Steroids reduce nerve irritation by inhibiting production of the proteins that cause inflammation.  The anesthetic blocks nerve conduction in the area where it's applied, numbing the sensation of pain.

An epidural spinal injection may be done either for diagnostic or therapeutic reasons. By injecting medication around a specific nerve root, your doctor can determine if that particular nerve root is the cause of the problem. When administered for therapeutic reasons, a spinal epidural injection may provide long- or short-term relief, anywhere from a week to several months. In some instances, an epidural spinal injection may break the cycle of inflammation and provide permanent relief.

It's important to note, however, that an epidural spinal injection is typically not considered a cure for symptoms associated with spinal compression. Rather, it's a treatment tool that a doctor can use to help ease pain and discomfort as the underlying cause of the problem is being addressed through a rehabilitative program such as physical therapy, or while the patient is considering surgical treatment options.

Surgery

METRx Minimally Invasive Hemilaminectomy

A hemilaminectomy is a spine surgery that involves removing part of one of the two laiminae on a vertebra to relieve excess pressure on the spinal nerve(s) in the lumbar spine, or lower back. A hemilaminectomy can be performed to relieve symptoms such as back pain and radiating leg pain.  A METRx hemilamectomy is a minimally invasive procedure performed utilizing METRx technologies.

In a traditional open lumbar laminectomy the two laminae and spinous process of a vertebra are removed to relieve excess pressure on the spinal nerves in the spine. The term laminectomy is derived from the Latin words lamina (thin plate, sheet or layer), and -ectomy (removal). A laminectomy removes or “trims” the lamina (roof) of the vertebrae to create space for the nerves leaving the spine.

Open Laminectomy

Laminectomy is an operation that involves removing a portion of the bone over and/or around the nerve roots to give them additional space. Your surgeon removes a portion of the lamina, the bony rim around the spinal canal, if it is contributing to pressure on the spinal cord or nerve roots.

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Posterior Fusion

Following a discectomy, laminectomy or other surgery that involves removing portions of one or more vertebrae to relieve pressure on the spinal cord and nerves, fusion instrumentation and bone grafting are used to stabilize the spine. Metal or non-metal instrumentation is put in place to hold the vertebrae together as the bone graft grows and fuses the vertebrae. These implants include rods, plates and screws that are left in place after the surgery. Bone grafts may be placed on the outside of the two vertebrae or between the vertebrae (interbody).

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Transforaminal Lumbar Interbody Fusion (TLIF)

A transforaminal interbody fusion (TLIF) is a technique where the disc is removed from the posterior approach. The bony endplates are scraped until rough and the space is filled with a plastic or metal cage and bone chipes to achieve a fusion between the vertebral bodies.

When combined with a posterior fusion, this provides 360° spinal stability without the need for a second anterior incision.

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Please keep in mind that all treatments and outcomes are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results and other important medical information.