“Lumbar spondylolysis” describes a unilateral or bilateral osseous defect (fracture) affecting the Pars interarticularis of one or more lumbar vertebra. (1-3) 90% of pars defects occur at L5. (4,5) An isolated spondylolysis is not associated with vertebral slippage, but when this defect occurs bilaterally, the anterior and posterior portions of the neural arch may separate, allowing for anterior translation of the vertebral body in relation to the segment below. (Spondylolisthesis) (6,7)
Overall, spondylolysis affects approximately 6% of the general population, and up to 8-14% of elite adolescent athletes. (1,2,8-10) The condition affects males almost twice as often as females. (3,8,11-13) Caucasians are affected two to three times more frequently than African Americans. (2,13)
The pathogenesis of spondylolysis is attributed to repetitive axial loading, especially in lumbar extension- from bony impingement by the inferior facet of the cephlad vertebra. (14-18) Repetitive stress leads to bony fatigue with an ensuing stress reaction and eventual stress fracture. The condition may occur more commonly in the presence of congenital abnormalities, like spina bifida occulta or a weakened or dysplastic Pars. (19) Genetics, weakness of the soft tissue supporting structures, and lumbar hyperlordosis may also contribute (20-24)
Spondylolysis is an acquired disorder that does not occur before ambulation. (9) Two-thirds of cases occur prior to first grade, with the remainder occurring during later childhood or adolescence. (1,8,25,26) Cases developing before adolescence seem to be less symptomatic, or possibly less recognized. The presence of spondylolysis in an adult is likely an incidental finding in the absence of concurrent spondylolisthesis with instability. (6) The condition is, however, the most common cause of chronic low back pain in adolescent athletes. (27)
The highest likelihood of spondylolysis/ spondylolisthesis occurs in track & field throwing sports (27%), gymnastics (17%), and rowing (17%). Other at risk athletic populations include those who participate in: diving, cheerleading, football, wrestling, weight lifting, rowing, track and field, swimming, tennis, and volleyball. (28-33) An excellent review by Patel (86) provides a sports specific break down of the incidence of spondylolysis and spondylolisthesis.
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What we do in our office to help this condition:
1. Perform a detailed exam, assessing the alignment of the spine. Due to the fact that the nerves exiting the spine in the low back branch off and go to the pelvis, groin, hips, knees, ankles, and feet, improper alignment in any of these areas may be detrimentally affecting the lumbar spine and its surrounding tissues.
2. As indicated, adjust areas of spinal subluxations (misalignments), restoring proper alignment and nerve system function, which facilitates healing.
3. Apply electrical stimulation and heat to the muscles of the low back. Applying an electrical current helps strengthen muscles, block pain signals, and improve blood circulation.
4. If there is degeneration or herniation of the disc that is compressing a nerve, we will recommend sessions on the decompression table. Spinal decompression is a non-invasive form of traction treatment that calls for the use of a special motorized table to relieve pressure, give spacing back to the spinal discs, and promote natural healing. When the pressure on the disc is decreased or relieved, it can often return to its normal position and stop the pain.
5. Prescribe stretches and exercises in conjunction with chiropractic care to strengthen the soft tissues of the low back, core, and lower extremities.