Spondylolysis: a review and reappraisal

Abstract

The aim of this review was to provide of the current knowledge in pathophysiology, diagnosis and management of spondylolysis based on the authors' experience and the pertinent medical literature. Spondylolysis represents a weakness or stress fracture in one of the bony bridges that connect the upper with the lower facet joints of the vertebra. It is the most common cause of low back pain in young athletes. One-half of all paediatric and adolescent back pain in athletic patients is related to various disturbances in the posterior elements including spondylolysis. The most common clinical presentation of spondylolysis is low back pain. This is aggravated by activity and is frequently accompanied by minimal or no physical findings. A pars stress fracture or early spondylolysis are common and a misdiagnosis is often made. Plain radiography with posteroanterior (P-A), lateral and oblique views have proved very useful in the initial diagnostics of low back pain, but imaging studies such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans are more sensitive in the establishment of the diagnosis. Several treatment options are available. Surgical treatment is indicated only for symptomatic cases when conservative methods fail. The fact that early and multiple imaging studies may have a role in the diagnosis of pars lesions and the selection of the optimal treatment approaches is also highlighted.

Keywords: low back pain; pars interarticularis; spine; spondylolisthesis; spondylolysis.

Figure 1. The one legged hyperextension manoeuvre

Figure 2. X-ray oblique views of the Lumbar Spine showing the defect in the pars interarticularis at the L4 level

Figure 3. Plain radiograph of the lumbar spine. The collar sign on the Scottie dog

Figure 4. T2-weighted MRI of the Lumbar Spine. Changes on the signal intensity at the L4 - L5 level indicative of spondylolysis