Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine
Currently, lower back pain affect approximately 60-90% of the population. These back pain can have several explanations, including isthmic lysis. Its causes are multiple and the most difficult is that its diagnosis can take time. It is a pathology that can remain silent for a long time. In case of aggravation, it can lead to pain in the lower back, at rest or while walking.
Causes, diagnoses, symptoms, treatments… discover all the essential concepts to know about isthmic lysis in this article.
Contents
Definition and types
THEisthmus is an anatomical structure of the spine (or spine). It separates the upper and lower joints of the lumbar vertebrae. We distinguish the right isthmus from the left isthmus, but they are all in the rear part of the vertebra.
In reality, the convex curves backwards (kyphosis) or forwards (lordosis), at the level of the dorsal vertebrae, play a major role in learning to walk. The development of these spinal curvatures ensures a better balance and a good maintenance of the weight of the upper body. Thus, they save effort in standing or walking. These curvatures also make it possible to adopt a normal profile and posture.
Because of these various movements of the back, the lumbar vertebrae regularly face shear stresses. The isthmus becomes more and more fragile, and sometimes ends up breaking.
So, the isthmic lysis translated a stress fracture. In other words, it is the progressive cracking of the isthmus.
The main ones types of isthmic lysis are :
- isthmic lysis L5: this is the most common case which concerns approximately 95% of cases. It designates a crack at the level of the upper part of the isthmus of the 5th lumbar vertebra (or L5).
- Isthmic lyses in L1, L2, L3 or L4 are rare and exceptional.
- Bilateral isthmic lysis: in the majority of cases (85%), unilateral involvement is bilateralize following pathological changes.
Le link between isthmic lysis and spondylolisthesis
If theslip isthmus, We are talking about " spondylolisthesis ". The latter then corresponds to sliding (listhesis) by vertebra (spondylo) forward, on the one just below.
Le spondylolisthesis pourrait following isthmic lysis. Indeed, the cracking of the isthmus (isthmic lysis) causes a loss of the posterior “frenum” which can evolve into a spinal slip ou spondylolisthesis.
To know everything about spondylolisthesis, see the following article.
Who can be affected by isthmic lysis?
La isthmic lysis is not present from birth. In general, it appears in children between 5 and 7 years old. Since at this age, this part of the vertebrae is very stressed, especially when learning to walk.
It also affects athletes:
- divers (in 63% of cases);
- weightlifters (36,2%);
- wrestlers (33,3%);
- gymnasts (32,8%).
Housewives are also the most affected among the elderly.
Etiology of isthmic lysis
Le spondylolisthesis due to isthmic lysis appears when developing spinal curvature. It is through this curvature that lordotic bipeds such as humans can walk with muscular balance. This is why it can happen after mastering walking (often from the age of 5).
The repeated stresses on the lumbar vertebrae leading to the fissure of the isthmus can also cause this stress fracture. They usually occur because of sports and physical labor.
In addition, it could have a genetic cause (brittle bone disease).
What are the symptoms of isthmic lysis ?
In most cases, it is difficult to recognize the isthmic lysis. It is usually asymptomatic. Although there is no consolidation of the fracture of the isthmus, slip don't get worse. The patient then feels no pain.
However, if the slippage (spondylolisthesis) gets worse, some symptoms appear.
In children, these are:
- opportunities, lower back pain ;
- a slight limp when walking.
In adults, they mainly appear around the age of 40:
- lower back and joint pain;
- pains of sciatic nerves along the legs;
- development of thelumbar osteoarthritis.
In the worst case, we see:
- decreased leg strength (due to sciatica paralyzing);
- severe neurological disorders and abnormal sphincter control (cauda equina syndrome);
- hyper painful and paralyzing sciatica.
How is isthmic lysis diagnosed?
First, a clinical examination is necessary. It makes it possible to determine the particular antecedents (previous traumatisms, work of force, affections of the anterior vertebrae).
The analysis of the various symptoms is then done, to better guide the diagnosis. To do this, physical examinations are necessary.
- An inspection of the spine as a whole: it makes it possible to detect any anomalies (presence of lumbar mass, abnormal posture).
- A palpation: to look for painful points, localized contractures. It is also used to assess spinal mobility.
Afterwards, the doctor performs paraclinical examinations at the level of the Lumbar spine. These help to detect lesions confirming the diagnosis. We can cite :
- A radiograph ;
- magnetic resonance imaging (or MRI);
- computed tomography (CT) or scanner;
- a scintigraphy.
How to treat isthmic lysis?
La stress fracture only requires surveillance, especially if she has no symptoms. They must be done every 6 to 12 months accompanied by a specific muscle strengthening program (by physiotherapy for example).
Otherwise, supported are carried out for the purpose of:
- relieve patients with symptomatic treatments;
- cure disease;
- avoid complications.
To choose the right treatment, it is important to take into account certain factors, such as:
- age;
- general state of health;
- usual activity (sports activities, profession, etc.);
- the morphology of the patient's column (vertebral dysplasia, balance in profile, evolution of sliding.
For the symptomatic treatment, administer medication:
- analgesics to relieve pain;
- muscle relaxants that relieve muscle contractures;
- corticosteroids and anti-inflammatories.
Personalized orthopedic treatments are also needed:
- temporary immobilization by wearing a corset (if the isthmic lysis is recent);
- sessions of re-education ;
- la physiotherapy (to soften the elements of the spine, reducing stress on the slipping vertebra).
If the radiographic evolution remains unfavorable and the pain persists, a surgical intervention is required.
It consists, in the majority of cases, in permanently welding the two vertebrae concerned (lumbar arthrodesis). This can be done by a bone graft to create a bone bridge between these two vertebrae. This process of osteosynthesis takes 3 to 12 months to obtain the expected results. During this time, the immobilization of the vertebrae by implants is essential. Usually screws, cages, rods or plates are used.
Conclusion
La isthmic lysis is a spinal pathology. She can touch all individuals at all ages. This disease is problematic if it hinders daily activities of the patient. It is not therefore very serious, except for the elderly. If the treatment is well conducted, there are conclusive improvements.
Sources
https://www.institut-kinesitherapie.paris/actualites/lyse-isthmique/
https://mal-de-dos.ooreka.fr/astuce/voir/652359/lyse-isthmique
Thesis of Paul KONATE "Isthmic lysis: clinical, radiological and therapeutic aspects in the Rheumatology department at the CHU du point G, Bamako", 2011
https://www.cfdos.com/spondylolisthesis-par-lyse-isthmique/
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