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Spondylolysis - Pars Stress Fracture

Spondylolysis is a stress fracture of a small bridge of bone in part of the vertebrae (called the pars interarticularis of the vertebral arch), one of the bones that make up your spine, and often begins because of a defect in your bone.

Common Signs & Symptoms

  • Pain and stiffness in your lower back which is worse with activity (especially arching back) and improves with rest
  • Pain may start from an episode where you arched your back

Description

Spondylolysis is a stress fracture of a small bridge of bone in part of the vertebrae (called the pars interarticularis of the vertebral arch), one of the bones that make up your spine, and often begins because of a defect in your bone. Most pars fractures occur in the lowest back vertebrae (called the L5), but spondylolysis can also occur in the other low back vertebrae, as well as in the middle back (thoracic) vertebrae.

Spondylolysis is reasonably common, occurs in three to six percent of the population and is often seen in sports where you repeatedly bend backwards into the same position, such as bowling in cricket, gymnastics and serving in tennis. It causes local pain in the area where the small fracture is but over time, you may suffer from degeneration of your spine and experience more serious complications including:

  • Spinal & Foraminal Stenosis – this is where the canal where the spinal cord runs down the back becomes narrow and the spinal cord is pinched and can occur in the neck or low back.
  • Cauda equina syndrome – where the nerves at the bottom of your spinal cord are pressed on by your disc or other structure and can cause severe nerve problems.
  • Radiculopathy – this is pinching of one or more spine nerves

Advice and Treatment

Diagnosis of pars fracture is normally with bone scans and X Rays - if these show any form of fracture, you must rest from activities which are painful or encourage back arching, use medication to control your pain and inflammation, and exercise your core muscles (tummy and back) to reduce the strain on your fracture and encourage healing.

The goal of treatment is to reduce the stresses going through your fracture to promote bone healing – to do this:

  • Relieve muscle spasm – medication, warm baths/heat and massage
  • Improve the mobility of your joints above and below the fracture (hip joints, middle back joints) using stretches or physiotherapy
  • Strengthen your core abdominal muscles – this will help them to stabelise your lower back and pelvis and reduce the movement at the area of your fracture, so exercises such as Pilates are ideal
  • Depending on the severity of your symptoms and the results of bone scans and X Rays, you may be asked to stay off your feet and get as much rest as you can by lying down for the majority of the day


Braces may be used to prevent any excessive movement or bad bending whilst your fracture is still healing.

Around 80–85% of will improve with these treatment, but for those with more severe problems and complications surgery is an option, but remains uncommon.

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