Spondylolysis, cervical

• Cervical spondylolysis

• 738.4 Acquired spondylolisthesis

• M43.00 Spondylolysis, site unspecified

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

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

Signs and Symptoms

• Pain in cervical spine, shoulder, arm, upper extremity
• Stiffness along spine
• Headaches
• Pain in cervical spine worsens with extension

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

Imaging

• MRI helps to visualize compressed or inflamed nerve root in diagnosis
• X-ray/plain-film radiograph to see vertebra position
• CT scan to show herniation compressing the spinal canal/nerves
• Electrodiagnostic/nerve conduction testing can help to determine a specific impaired nerve function

• Stress fracture of the pars

• For imaging
• For surgical consult if myelopathy is suspected
  • Fusion
  • Decompression
  • Laminectomy
  • Hemilaminectomy
• For corticosteroid injection, anti-inflammatory medication
• For halo vest traction device, cervical bracing

• Restricted mobility of the upper cervical spine
• Hypermobility
• Weakness noted of neck musculature

• Rest
• Bracing
• Address Pain
  • Electrical stimulation
  • Heat/ice
• Address hypertonicity
  • Soft-tissue massage
  • Heat
• Address muscle weakness
  • Stability exercises

• Patient will be able to
  • Sit with neutral cervical spine posture for greater than 30 minutes with 0 out of 10 pain rating
  • Stand at work station and perform computer work for 45 minutes with 0 out of 10 pain rating
  • Rotate cervical spine 75 degrees so as to look over the shoulder while driving the car with 0 out of 10 pain rating

• Fair to good depending on severity of vertebral translation, amount of nerve-root compression, and upper/lower-extremity impairments