When talking about alterations in the structure of the spine due to back pain, it is important to take into account what it is about and what is the spondylolysis. Spondylolysis is the rupture of the lamina of the vertebra, so that the facet joint is separated from the rest. The most frequently affected vertebra is the fifth lumbar, continued from the fourth.
In most cases when spondylolysis affects the fourth lumbar, a sacralization of the fifth lumbar is generated.
In this sense, it must be known that young people are more exposed to their development., since his bones are still growing. Children and adolescents who do sports or other physical activities that may strain the lower back or involve bending the back, mostly backwards, like ballet, golf, wrestling or american football, are more prone to their development.
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How spondylolysis occurs
In most occasions, spondylolysis is not a true tear in itself, but the bone does not form. In this type of case, the separation between the facet joint and the rest of the lamina exists from birth and is constantly maintained throughout your life.
On other occasions, in which the bone becomes formed in the correct way, the vertebral lamina ruptures as a result of repeated trauma or falls. This happens regularly to athletes and usually takes between 6 u 9 months to recover spontaneously.
Symptoms of spondylolysis
On a regular basis, spondylolysis does not cause any symptoms or pain; and is only found by a chance finding on an x-ray when trying to detect another problem. This occurs especially in those spondylolysis that appear as a consequence of a defect in bone formation.
The spondylolysis that appear as a result of a repeated fracture or trauma can lead to pain in the vertebral area. Therefore, The demonstration that there is a spondylolysis in a patient with back pain does not mean that this is the one that is actually causing the pain; and in fact, it is only considered to be this case, in those in which it is given by a fracture that has taken place recently.
Risks
When spondylolysis occurs on the left and right sides at the same time, there is a risk, since the vertebra could slide back and forth, appearing what is known as spondylolisthesis. Nevertheless, this does not happen every time; and spondylolysis can be observed regularly in healthy people without them suffering any kind of discomfort or pain due to it.
Diagnosis of spondylolysis
For diagnosis of spondylolysis, the health professional will do a physical examination, during which the patient's back will be pressed or asked to bend backwards, so that the spine can be hyperextended. In the event that any kind of pain is found while doing so, it may be a fracture.
Other issues, like muscle pain, pinched nerves or protruding herniated and compressed discs can also lead to lower back pain. To rule out these options or to confirm the diagnosis of spondylolysis, health professionals will order tests such as bone scan.
Similarly, it may be advisable to carry out a Bone scintigraphy, which will be used in these cases:
- To confirm the existence of spondylolysis when the radiograph does not show it clearly, or when looking to rule out general diseases such as fever or infections.
- To distinguish if spondylolysis has to do with a lack of bone formation or is the result of a break. If it is due to lack of bone formation, the scan is normal. In the case of spondylolysis due to bone breakage, scintigraphy is able to detect rupture during 7 days from the moment the break took place.
- In order to monitor the bone healing process, scintigraphy can be used for spondylolysis due to ruptures due to repeated trauma. In this way, information can be known to define the moment in which an athlete, for instance, can go back to training.
Treatment of spondylolysis
In cases where spondylolysis occurs due to a bone formation defect, and there is no spondylolisthesis associated with it, nothing should be done as treatment. In these cases, it is considered that spondylolysis is not a disease, rather it is a finding that has taken place by chance.
In spondylolysis cases, it is caused by the breakage of a bone, from repeated fracture or trauma, it is advisable to reduce or suspend efforts until recovery is achieved, especially in the case of athletes, intense workouts.
In this sense, can indicate the corset for patients in whom spondylolysis is caused by a break in the bone and not by lack of training; and when pain persists despite reduced activity and treatment. It is necessary to take measures to prevent muscle atrophy from occurring; and then the corset will be progressively removed as soon as possible.
It is also possible to resort to surgery, Although it is indicated only in those cases in which the pain persists despite the treatments that have been applied during a period of 9 months; or if it has been proven that it is due to spondylolysis due to bone breakage and that it does not resolve 9 months later.