Spondylolysis, lumbar

• 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 across the back region
• Often no symptoms
• Weakness in the pars

Essentials of Diagnosis

• Diagnosis made by x-ray
• Can be acquired or congenital
• Back pain

General Considerations

• Instability
• Avoid extension positions that increase symptoms
• Thin vertebral bone: pars

Demographics

• Onset most often during teenage years
• Runs in families

Signs and Symptoms

• Back pain
• Stiffness along spine
• Pain in lumbar spine worsens with extension

Functional Implications

• Difficulty maintaining standing postures secondary to back pain
• Inability to sleep flat on back without a pillow
• Difficulty with movements (bending over) secondary to pain
• Limit sports participation

Possible Contributing Causes

• Forceful extension as a result of a hit from behind (as in sports)
• Congenital
• Car accident, hit from rear
• Hyperextension of the lumbar spine
• Increased 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 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

• To hospital for imaging
• To physician for surgical consult if myelopathy suspected
  • Fusion
  • Decompression
  • Laminectomy
  • Hemilaminectomy
• To physician for corticosteroid injection
• To physician for anti-inflammatory medication
• To orthopedist for lumbar bracing

• Restricted mobility of the lumbar spine
• Hypermobility
• Noted weakness noted of core musculature

• Rest
• Bracing
• Ergonomic training
• Address pain
  • Electrical stimulation
  • Heat/ice
• Address hypertonicity
  • Soft tissue massage
  • Heat
• Address muscle weakness
  • Core stability exercises

• Patient will be able to
  • Sit with neutral lumbar 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 lumbar spine in order to lift/pick up items off the floor with 0 out of 10 pain rating

• Very good with proper ergonomic training, strengthening, and precautions