Stress fractures of the lumbar spine, aka spondylolysis, are one of the most common causes of low back pain in children and young adults, particularly athletes. The athlete will typically complain of progressively worsening low back pain without any specific injury to trigger it. The pain typically spreads across the low back, and is initially mistaken for a muscle strain. The pain usually does not radiate down into the legs.
The stress fractures are caused by damaging the pars interarticularis, the section of vertebrae that helps connect the vertebra above and below it. There are a number of theories to explain why this injury occurs, but one of the suspected factors is repetitive extension of the low back. In fact, athletes in sports that require those types of repetitive movements, such as gymnastics, weight lifting and football, have a higher rate of occurrence.
Spondyloysis can sometimes be diagnosed with a simple xray. However, a CT scan or MRI is usually needed to confirm the diagnosis. Once the diagnosis is made, rest and control of the pain are the primary treatments. There is debate regarding the need to brace the patient, or whether simply avoiding the aggravating activities is sufficient for healing. Ultimately, it comes down to the preference of the physician and the patient. Once the pain is resolved, an aggressive course of physical therapy is recommended focusing on core strength to get athlete’s prepared to return to their sport and help prevent recurrence.
Due to the location of the defect, spondylolysis can lead to instability of the vertebral segments above and below. The top segment can shift in relation to the bottom segment, which is called spondylolisthesis. Severe injuries can lead to this quickly, but more frequently the instability and shifting occur gradually over time, leading to chronic low back pain as the athlete gets older. The risk of long term low back problems emphasizes the need for prompt and accurate diagnosis and treatment of this condition.
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