Spondylolysis: Difference with spondylolisthesis (Causes)

spondylolysis spondylolysis

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

Le back pain may be a sign of spondylolysis. It is a back condition that can appear in both children and adults. Being not very symptomatic, the diagnosis of this disease can be late. And over time, it can also evolve and become more serious.

In this article, we present in detail the spondylolysis in order to receive timely treatment and prevent complications.

Definition of spondylolysis

La spondylolysis, also called " isthmic lysis », designates a lesion or a rupture of the articular isthmus (pars interarticularis).

The articular isthmus is the solution of continuity between the superior articular process and the inferior articular process of the posterior vertebral arch. This is the part of the vertebra that provides stability to the spine.

If the isthmus is affected, the mobility between the articular facets can be disturbed. Indeed, this can cause the destabilization of the affected vertebra. Micro-mobility or mobility of the posterior vertebral arch can also occur. In general, the attack is located at the level of the fifth lumbar vertebra (L5).

What is the difference between spondylolysis and spondylolisthesis?

Le spondylolisthesis indicates a slippage of a lumbar vertebra forward relative to that below. This shift is usually gradual and slow. It can follow a congenital malformation, a lumbar arthritis or to a isthmic lysis.

Therefore, they are two different diseases. If spondylolysis results in a simple rupture of the isthmus, spondylolisthesis results in a permanent displacement of a vertebra. However, spondylolysis can progress to isthmic spondylolisthesis.

The causes of spondylolysis

La rupture of the pars interarticularis does not result from a single trauma, but from a repetition of excessive stresses exerted by the vertebrae located above. It is therefore due to repetitive trauma (stress fracture). This is why isthmic lysis is called a “fatigue fracture”.

In rare cases, trauma can cause spondylolysis. It can also be related to congenital factors or hereditary factors.

Epidemiology of spondylolysis

In the general population, the frequency of isthmic lysis rises up to 8%, and even more in certain ethnic groups. The groups most at risk are the San and the Inuit. In the latter, about 40% are affected.

As spondylolysis is a stress fracture, athletes are usually the most affected. These include:

  • dancers, 20% of whom have it;
  • high-level athletes whose attack rate is 14%;
  • gymnasts and rowers, 11 to 17% of whom suffer from it.

Risk factors for spondylolysis

Regular and intense sports activity can promote isthmic lysis. The sports which expose more to the risks of lysis are artistic gymnastics, swimming (butterfly), football, rowing, discus throwing, javelin...

Growth is also one of the risk factors for this pathology, as is a singular anatomy of the spine. And this, in particular in the event of repeated movements at a high angle of incidence or in hyperlordose.

Symptoms of spondylolysis

In 80% of cases, this affection of the articular isthmus is bilateral. In other words, the lesion is present on both sides of the posterior arch. Nevertheless, it can be unilateral in 10% of cases.

Most of the time, this disease remains silent for several years. On the contrary, when the symptoms of spondylolysis manifest, they often appear as Chronic Pain. This pain comes from pressure on the spinal cord or nerves. Indeed, Gill's nodule, formed when the isthmus ruptures, can attack the latter.

More specifically, it can be:

  • low back pain (lower back pain);
  • muscle spasms;
  • de sciatic pain (legs).

Diagnosis of spondylolysis

Le diagnosis of spondylolysis is based on various tests such as:

  • a x-ray of Lumbar spine: it makes it possible to show the rupture of the articular isthmus. To be able to observe it distinctly, the specialists carry out profile or ¾ x-rays. It is difficult to visualize the vertebral isthmus on a simple frontal X-ray of the back;
  • un scanner: this examination can highlight the fracture of the isthmus;
  • a Lumbar MRI: it offers more diagnostic information regarding the inflammatory nature of the disease in the presence of pain. It also allows the evaluation of the quality of the disc between the two vertebrae in front as well as the search for any other vertebral damage such as a herniated disc or an disc protrusion ;
  • a bone scan: this examination makes it possible to confirm if there is a pathological remodeling with hyperfixation.

How to treat spondylolysis?

Orthopedic treatment in children

Only reserved for children, this treatment is offered when the disease is discovered at an early stage. It consists of an attempt to consolidation with a corset. On the other hand, for an old fracture, immobilization alone is insufficient.

Drug treatment for spondylolysis

In general, the first treatment offered by doctors is of the drug type. For this, they prescribe:

  • analgesics to relieve pain;
  • nonsteroidal anti-inflammatory drugs;
  • muscle relaxants to soothe muscle contractures.

If necessary, corticosteroid injections can be prescribed.

In addition to drug treatments for spondylolysis, a temporary suspension of sporting activities or rehabilitation at the end of the sporting gesture may prove necessary. The same is true for wearing a corset or a lumbar belt to immobilize the lumbosacral region.

It should be noted that no treatment is necessary in the absence of pain. However, it is advisable to limit strenuous activities for the back.

Physiotherapy treatment for spondylolysis

In combination with drug treatment, it is possible to use physiotherapy. The sessions can be followed on medical prescription. This treatment begins by taking an assessment to determine the type of pain felt by the patient. Depending on this, the physiotherapist chooses the appropriate techniques to treat pain and strengthen the muscles. He also gives ergonomic advice for maintaining your back, muscles and mobility.

Surgical treatment of spondylolysis

Le surgical treatment for spondylolysis is recommended when:

  • lumbar pain recur and become disabling;
  • sciatic pain occurs;
  • drug treatment proved ineffective.

This type of treatment is therefore not systematic. It is only offered as a last resort. In the majority of cases, surgical treatment consists of combining a lumbar arthrodesis with osteosynthesis. These operations involve surgically fixing two affected lumbar vertebrae using a screw, pins or plates. We also speak of spondylodesis.

The purpose of the surgical intervention is thus to remedy the instability caused by the stress fracture by performing a fusion. At the same time, it will also calm the pain. To this end, different devices are used for specific surgical procedures.

The risk of complications depends on the surgical approach chosen. If the risk of serious neurological complication is close to 0%, the risk of an infection reaches 2 and 3%. All probable risks are assessed during the preoperative consultation itself.

References

https://fr.wikipedia.org/wiki/Spondylolisth%C3%A9sis

https://mal-de-dos.ooreka.fr/astuce/voir/652359/lyse-isthmique

https://www.info-radiologie.ch/spondylolyse.php

https://www.sciencedirect.com/science/article/abs/pii/S0765159799800239

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