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117: CERVICAL SPONDYLOLYSIS

Eric Shamus, PhD, DPT, PT, CSCS; Eric J. Chaconas, DPT, PT, FAAOMPT

CONDITION/DISORDER SYNONYM

  • Cervical spondylolysis

ICD-9-CM CODE

  • 738.4 Acquired spondylolisthesis

ICD-10-CM CODE

  • M43.00 Spondylolysis, site unspecified

PREFERRED PRACTICE PATTERN

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1

PATIENT PRESENTATION

A 29-year-old man presents with acute neck pain after trauma to the cervical spine during soccer practice. He was immobilized with a rigid cervical collar for 6 weeks after advanced imaging confirmed a pars defect at the C4 level. Currently, he presents with guarded movement in all directions and increased tone and tenderness in the cervical spine musculature. Significant weakness is noted in the longus colli, longus capitis, middle trapezius, and rhomboids. Neurological examination is negative, and the patient’s goal is to return to playing soccer.

KEY FEATURES

Description

  • Stress fracture of the pedicles on the vertebra below

  • Tightness or pain in the neck region

  • Often no symptoms

  • Weakness in the pars

Essentials of Diagnosis

  • Diagnosis made by X-ray

  • Can be acquired or congenital

  • Neck pain

General Considerations

  • Instability

  • Avoid extension positions that increase symptoms

  • Thin vertebral bone: Pars

Demographics

  • Teenagers with high-risk activities are more at risk

  • Runs in families

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Pain in the cervical spine, shoulder, arm, upper extremity

  • Stiffness along the spine

  • Headaches

  • Pain in the cervical spine worsens with extension

FIGURE 117-1

Schematic drawings of spondylolysis (A), and spondylolisthesis (B). (From Patel DR, Greydanus DE, Baker RJ. Pediatric Practice: Sports Medicine. www.accesspediatrics.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Functional Implications

  • Difficulty sustaining standing postures secondary to neck and arm pain

  • Inability to sleep flat on the back without a pillow

  • Difficulty with movements (reaching overhead) secondary to pain

  • Limit sports participation

Possible Contributing Causes

  • Forceful extension from hit under the chin (sports)

  • Congenital

  • Car accident, hit from rear

  • Hyperextension of the cervical spine

  • Increased cervical lordosis posture

Differential Diagnosis

  • Peripheral nerve impairment

  • Spinal tumor

  • Peripheral neuropathy

  • Paraspinal spasms

  • Degenerative disk disease

  • Stenosis

MEANS OF CONFIRMATION OR DIAGNOSIS

Imaging

  • MRI helps to visualize compressed or inflamed nerve root in diagnosis2

  • X-ray/Plain-film radiograph to see vertebra position3

  • CT scan to show herniation compressing the spinal canal/nerves3

  • Electrodiagnostic/nerve conduction testing can help determine a specific impaired nerve function4...

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