Lumbar spondylolysis - Current concepts review

Abstract

Lumbar pars interarticularis (PI) injury or spondylolysis occurs only in humans. This represents a stress fracture of the PI. Excessive loading in repetitive hyperextension is a significant risk factor and occurs most commonly at L5 followed by L4. It is bilateral in 80% of symptomatic cases but can be unilateral defect as well which runs a more benign course. Symptoms of low back pain relating to this lesion are more common in young athletes involved in trunk twisting sports. Like other stress fractures, the pain may come on abruptly or more insidiously over time and only related to certain activities. The pathologic progression starts with a stress reaction in the pars, progressing to an incomplete stress fracture, and then a complete pars fracture. Diagnosis is dependent on clinical examination and radiological imaging studies (plain radiography, computed tomography (CT) scans and magnetic resonance imaging (MRI) scans). Treatment is dependent on symptoms as well as radiographic stage of the lesion. Conservative management is the mainstay of treating early lesions. A comprehensive rehabilitation program incorporates core spinal stabilization exercises. Athletes should not return to sports until pain free. Professional sporting individuals are at increased risk of failure of resolution of symptoms that may require early surgical repair of the PI defect. Modified Buck's technique & pedicle screw-hook constructs for direct repair has a high success rate in patients who have persistent low back pain. Minimally invasive lumbar pars defect repair has given similar successful outcome with added advantage of minimizing muscle injury, preserving the adjacent joint and reduced hospital stay. Functional outcome is evaluated using the Visual Analogue Scale (VAS) for back pain, Oswestry Disability Index (ODI) and 36-Item Short-Form Health Survey (SF-36). Preoperative ODI and SF-36 physical component scores (PCS) are significant predictor of a good functional outcome.

Sciatica. Management for family physicians

“…Several guidelines have been published to guide the physician diagnostic workout to avoid unnecessary imaging or testing. [ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 ] Most of them recommend further studies if symptoms last longer than six weeks or the so-called “red flags” are present [ Table 2 ].…”

Development and biomechanical analysis of an axially controlled compression spinal rod for lumbar spondylolysis

“…Acquired traumatic factors include stress fractures induced by intense and periodic physical activity, which is high among wrestlers and weightlifters. [1] Currently, LS treatment options are categorized into conservative and surgical approaches. [2] Surgical intervention is recommended if intractable low back pain persists after 6 to 12 months of conservative treatment.…”

“…Lumbar spondylolysis (LS) is a common orthopedic disease characterized by discontinuous bone defects in the unilateral or bilateral isthmus of the lumbar spine, often resulting in lumbar spondylolisthesis. [ 1 ] Both congenital factors and acquired trauma can trigger LS, with its symptoms typically manifesting as intractable lumbago, although some patients remain asymptomatic. [ 1 ] LS most frequently occurs at the L5 level, followed closely by L4.…”

“…[ 1 ] Both congenital factors and acquired trauma can trigger LS, with its symptoms typically manifesting as intractable lumbago, although some patients remain asymptomatic. [ 1 ] LS most frequently occurs at the L5 level, followed closely by L4. [ 1 ] Notably, 80% of patients experiencing lumbago present with bilateral spondylolysis.…”

“…[ 1 ] LS most frequently occurs at the L5 level, followed closely by L4. [ 1 ] Notably, 80% of patients experiencing lumbago present with bilateral spondylolysis. [ 2 ] Factors contributing to LS encompass genetic predisposition and acquired traumatic incidents; for example, Eskimos show a higher incidence rate of LS, highlighting the influence of genetic factors.…”