Thankfully, the number of patients undergoing surgery for these problems is low compared with the total identified. Surgical intervention may be indicated for patients with recalcitrant pain despite good conservative care or patients with progressive neurologic decline or progressive slippage beyond 25 to 50 percent.The plan for a symptomatic patient with slippage up to 50 percent includes activity modification and physical therapy with development of a home exercise program involving core work/abdominal strengthening, postural control and hamstring stretching.For a patient with up to 25 percent slippage without symptoms, the recommendation may be no restriction of activity and semiannual radiographs.
The baseline recommendation for a patient with an incidental and asymptomatic pars defect is usually no restriction of activity and annual radiographs through skeletal maturity.Here is our general guidance formanagement of these conditions: Athletes trigger special considerationsīecause activity restriction is a component of early management in many cases, return-to-play considerations can be difficult. The braces/spinal orthoses are used to maintain lumbar flexion to counteract extension forces through the pars. Response to bracing is more predictable and favorable with acute process without evidence of bony sclerosis. Simple medications (e.g., acetaminophen or NSAIDs such as ibuprofen or naproxen) and education are often the first steps in management.Īdvanced imaging aids in determining the acuity of spondylolysis. The treatment of patients with spondylolysis or spondylolisthesis ranges from observation to restriction of activities/athletics, bracing and surgery. Spondylolytic fatigue fracture of pars interarticularis.The most common type of spondylolisthesis is the isthmic or spondylolytic spondylolisthesis, which can be divided into subtypes as follows: The Meyerding grading classification is used to describe the degree of slippage of the upper vertebra on the lower one: Advanced imaging studies (MRI, CT, and bone scan with SPECT) can provide greater detail and help determine the treatment course. Spondylolysis can be appreciated on oblique lumbar radiographs. Standing anteroposterior and lateral lumbar radiographs (Figure 1) help define any underlying alignment concerns that may be missed on studies while the patient is lying down. Physical exam findings in patients with these conditions may include tight hamstrings, crouched or waddling gait, or even palpable step-off.Īlthough the history and physical exam findings may raise the level of suspicion, the diagnosis is confirmed with imaging. Repetitive flexion/extension motion is thought to be a key factor in the development of spondylolysis and aggravation of painful symptoms. Symptoms of these conditions may include dull, aching low back pain that is worsened with athletic activities. There is a higher incidence of spondylolysis in certain populations, including athletes- particularly gymnasts, divers, football linemen, tennis players, divers and rowers. Spondylolysis may be present in 5 to 10 percent of a normal population and is the most common cause of spondylolisthesis. Made up of the Greek roots for “vertebra,” “break” and “slipping,” spondylolysis refers to a defect in the pars interarticularis (the segment of the vertebral arch lying between the superior and inferior articular processes) and spondylolisthesis refers to a defect with slipping of one vertebra on another.īoth conditions are relatively common in children and adolescents. We do not endorse non-Cleveland Clinic products or services Policy Advertising on our site helps support our mission. Cleveland Clinic is a non-profit academic medical center.
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