Spondylolysis is an injury to the lamina of the vertebra so that the facet joint is separated from the rest of the vertebra. The vertebra that is most frequently affected is the fifth lumbar, followed by the fourth. In most cases in which spondylolysis affects the fourth lumbar, there is a sacralization of the fifth lumbar.
How does it happen?
In most cases, it is not a true break, but the bone does not form. In these cases, the separation between the facet joint and the rest of the lamina exists from birth and is constantly maintained throughout life.
In other cases, in which the bone is formed correctly, the vertebral plate is broken as a result of repeated falls or trauma. That typically occurs in athletes and usually takes 6 to 9 months to repair spontaneously.
Frequently, spondylolysis does not cause any pain or symptoms and is only a casual finding on an x-ray. This occurs especially in the spondylolysis that appears as a result of a bone formation defect.
Spondylolysis that appear as a result of a fracture or repeated trauma can cause pain in the vertebral zone.
Therefore, demonstrating that there is a spondylolysis in a patient with back pain does not necessarily mean that it is the cause of his pain. In fact, it is only considered it is when in the presence of a recent fracture.
When spondylolysis exists on both sides (left and right), the vertebra can slide forward or backwards, a spondylolisthesis appearing.
However, this does not always happen and spondylolysis is often observed in healthy patients without any pain or discomfort.
To diagnose spondylolysis, an x-ray is necessary. It may also make sense to do a bone scan. It makes sense to do it:
-To confirm the existence of spondylolysis when the radiographic image is not clear or should rule out general diseases (such as infections or tumours).
-To distinguish whether spondylolysis is due to the lack of bone formation or its rupture.
-To monitor the progress of bone healing, in spondylolysis due to its rupture due to repeated trauma in athletes. That can serve to define the moment from which they can retrain.
In cases where spondylolysis is due to a defect in bone formation and there is no associated spondylolisthesis, nothing needs to be done. In these cases, spondylolisthesis is not a disease, but only a casual finding.
In cases where spondylolysis is due to a broken bone, due to fracture or repeated trauma, it is advisable to reduce or suspend efforts until it recovers – including intense training in the case of athletes.
The corset can be indicated in patients in whom the spondylolysis is due to the breakage of the bone – and not to its lack of formation – the pain persists despite the reduction in activity and treatment. In these cases, it is necessary to take measures to avoid muscular atrophy and remove the corset progressively as soon as possible.
Surgery is indicated only when:
1. The pain is maintained despite the treatments applied for 9 months.
2. It has been found to be due to spondylolysis due to bone breakage and is not resolving after 9 months.
In these cases, it is indicated to perform an arthrodesis that affects only the segment in which the spondylolysis is, usually between the fifth lumbar and the first sacral.
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