Spondylolysis

Spondylolysis - a very small lesion

Spondylolysis itself is damage to a small piece of bone, or more precisely, a vertebra. A pair of articular processes extends from the vertebra: one upward and the other downward. The passage between them is damaged - this is called the vertebral isthmus or knot. It's a very small place, but it carries a very heavy load, especially when performing a movement of overstretching, i.e. bending backward or flexion.

Spondylolysis - beware of bending and overstretching

Spondylolysis is treated somewhat like a fatigue fracture. If we take a paperclip, bend it once and straighten it, nothing will happen yet. However, if we keep straightening and bending it, the microdamage will add up and a break will occur. This is exactly the case with chiropractic - the injury occurs when training in sports that require frequent bending and straightening, especially if accompanied by additional force. Certain groups of athletes are more predisposed, such as football players, volleyball players, basketball players and wrestlers.

Spondylolysis - a problem for one in twenty Europeans

A significant factor in causing injury is how the bony elements line up in relation to each other. Not everyone has the right anatomical predisposition for a particular sport. Especially when there is a summation of overload over a short period of time. Spondylolysis can be unilateral or bilateral, because the isthmus is located on both sides of the vertebra. It appears as a sum of coincidences. Statistics on the European population show that chiropractic (and the Spondylolysis that can result from it) affects about 5 percent of people. In most, it will be asymptomatic - these people will not even know about the affliction if they do not strain their backs. In athletes, this condition is more common - affecting 7-10 percent. The study also shows that chiropractic injury - of all sports - most often affects... water jumpers! Practicing this sport involves non-anatomical movements of overstretching - with very high force in a short period of time. More than 40 percent of jumpers have a problem with this condition!

Spondylolysis - injury to two lumbar vertebrae

Spondylolysis, of course, does not affect the entire spine, but only the lumbar spine and the last two vertebrae: the fourth lumbar and fifth lumbar vertebrae. It accounts for more than 98 percent of all cases. It also most often affects young people before the age of 20 - mostly patients after the age of 13. However, this is an underreported statistic, as chiropractic is one of the most undiagnosed conditions. In the case of our clinic, diagnostic testing is done somewhat differently than in open treatment, and this allows us to detect the problem more often.

Spondylolysis - when a break doesn't do much...

The symptoms of chiropractic are very uncharacteristic - it just hurts the back. Usually it starts with pain on one side, then both sides hurt or only the other. This pain occurs especially during physical activity. Trainers then usually order a break and the pain subsides. Only that when returning to training - it reappears again. When such a thing is neglected and passed over, the pain will become constant, such as during any activity at home. However, it will still be the greatest during heavy physical exertion. Mostly such a patient is advised to take a break from sports, undergoes diagnostics, which is usually a normal X-ray. Such an X-ray is able to signal a problem with chiropractic, but usually only a suspicion of the condition. The diagnostic examination should then be performed in three classic projections: front, side and oblique.

Spondylolysis - additional diagnosis

Very often it is necessary to carry out additional diagnosis. Ideal in this situation will be a CT scan, which perfectly shows the bone and its structure. Very often, a Spondylolysis is such a tiny fissure, which is less than a millimeter within the bone. The problem may be that 13-, 14- or 15-year-old children should not have a CT scan, except in special cases like cancer. Some MRI labs, including those at Rehasport Clinic, have a special program for processing MRI images. This is called an isovolumetric MRI, and you can see the vertebrae from it, because it gives a spatial image.

Generally, for a chiropractic injury to occur, several things must happen:

• a young person is affected
• there is pain on movement
• the nature of the activity is important
• problems occur during high activity, as well as during athletic activity
• is the result of frequent movements having a flexion-extension character

The patient very often says that after complete rest the pain subsides, and after classical rehabilitation it not only does not go away, but even increases.

Spondylolysis - the treatment process

We try to conduct treatment in such a way that there is no need for surgical intervention. Spondylolysis mostly affects young, physically active people, so we try to rehabilitate patients without surgery. However, the rehabilitation process is different from that of classic back injuries. This is because we avoid performing flexion or pronation movements.

Typically, the treatment process begins with five to six weeks of complete withdrawal from sports. In addition - the patient has an "upright regime", should walk straight and avoid bending. In some cases, we recommend using a special corset to remind the patient of straight posture.

Spondylolysis - the second stage of conservative treatment

This rather long period of the first part of rehabilitation can sometimes be frustrating for young people who are used to a lot of physical activity. In the second stage, we move to the actual rehabilitation and gradually introduce the process of muscle activation. At first it is done without movement, then movements of the trunk and limbs are incorporated, with increasing force. Everything is done under the supervision of a physiotherapist, who also evaluates the possibility of increasing the range of motion.

This second period lasts about six weeks, and we try not to shorten it. The whole thing gives a good chance of success - after 12-weeks we ask the patient to return to activity, but without full involvement in the initial phase. The condition for a full return to sports is the absence of pain. It is also important to remember the contraindications: it is necessary to exclude from training the most unfavorable movements.

Spondylolysis - the need for surgery

Unfortunately, it sometimes happens, although rarely, that such three-month conservative treatment is not enough and it is necessary to surgically anastomose the vertebral column. Since it is a very small bone element, it is fused with very small rods. A tiny screw connects the two elements, and we do this percutaneously, meaning without cutting the skin.

The surgery is followed by the same treatment protocol, which again lasts three months. Very often, parents, if they learn about the need for surgery, advise their children to give up intensive sports training. Awareness is very important - parents should pay attention to whether their children are over-exercising during activities.

If we have chiropractic on both sides, then another condition is already developing, namely chiropractic. It is a consequence of chiropractic and more often affects older people who have not been bothered by chiropractic. However, the neglected injury developed.

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Learn about other possible causes of spine problems.

Bibliography:

• Rita Grazina, Renato Andrade, Filipe Lima Santos, José Marinhas, Rogério Pereira, Ricardo Bastos, João Espregueira-Mendes, Return to play after conservative and surgical treatment in athletes with spondylolysis: A systematic review, Physical Therapy in Sport, Volume 37, 2019, Pages 34-43
• Sara Goetzinger, Selen Courtney, Kathy Yee, Matthew Welz, Maziyar Kalani, Matthew Neal, "Spondylolysis in Young Athletes: An Overview Emphasizing Nonoperative Management", Journal of Sports Medicine, vol. 2020, Article ID 9235958, 15 pages, 2020.
• Tsukagoshi, Y., Kamegaya, M., Tatsumura, M. et al. Characteristics and diagnostic factors associated with fresh lumbar spondylolysis in elementary school-aged children. Eur Spine J 29, 2465–2469 (2020).
• Paul Gagnet, Kent Kern, Kyle Andrews, Hossein Elgafy, Nabil Ebraheim, Spondylolysis and spondylolisthesis: A review of the literature, Journal of Orthopaedics, Volume 15, Issue 2, 2018, Pages 404-407