The spine is composed of a series of bones called vertebra connected to each other. In 5 percent of adults, a developmental fracture is present in the bony part connecting the lower and upper joints of the lowermost vertebras of the lumbar region. This fracture can be on one or both sides of the spine. Generally, these are stress fractures occurring from overloading in the lower vertebras, which are quite mobile. These fractures are called "spondylolysis".
This part of the spine is very mobile; therefore its fractures may fail to heal in most cases. While these fractures can cause pain in adolescents, it may not cause significant problems in adults.
In some patients, the vertebrae above may slip off the vertebra below. This is called "slipping of the back" or "spondylolisthesis". Spondylolisthesis may result in significant problems depending on the amount of slipping. "Lumbar slipping" that occurs as a result of this type of fracture is called "isthmic spondylolisthesis" and is often seen as slipping of the L5 vertebra over S1 vertebra.
What Are the Symptoms?
Stress fractures may not always produce symptoms. In some cases, they are seen as an incidental finding on lumbar X-rays taken for other reasons. If there are clinical symptoms, they may be lower back pain, buttock pain, and tenseness in lumbar muscles and, rarely, numbness in the legs, sciatic pain, and loss of muscle power in the feet. The pain increases while standing, walking and other activities, and decreases with rest.
How is it Diagnosed?
If your doctor considers spondylolysis after listening to your complaints and physical examination, he will request films. However, stress fracture (spondylolysis) may not be visible on plain X-rays. In that condition, your doctor may order a scintigraphy and/or CT if he still suspects a fracture. If these tests reveal a fracture, an MRI may be needed to plan treatment.
What are Treatment Options?
The pain due to stress fracture (spondylolysis) generally resolves with rest and other conservative treatments. However, the fracture in these patients may not always heal. Failure of the fracture to heal does not cause a threat as long as the pain resolves. In general, a severe shift is not expected in these patients at advanced age. Nevertheless, follow up with X-rays may be necessary.
When is Surgical Therapy Needed?
Surgical treatment may be necessary in patients whose complaints do not respond to conservative management. Two types of surgery may be applied in spondylolysis. The first is the repair of the fractured area, and the other is spinal fusion. This surgery is usually successful in patients younger than age 20, with intact (non-degenerated) disks.
The surgery can be performed from the front, back, or both. Fixation materials may be used. Healing is accomplished with an optimal postoperative rehabilitation program