II. Epidemiology
- Uncommon cause of back pain in general population
- Common cause of back pain in athletes
- Gymnastics, ballet or dance
- Football (e.g. blocking)
- Volleyball (e.g. serving the ball)
- Soccer
- Weightlifting
III. Pathophysiology
- Repetitive back hyperextension
- Causes Fracture at pars interarticularis resulting in Pars Interarticularis Defect
- Most commonly occurs at L4 or L5
IV. Symptoms
- Back pain exacerbated by Lumbar Spine hyperextension
V. Signs
- Hyperlordotic curvature of the Lumbar Spine
- Decreased Lumbar Spine range of motion
- Hamstring tightness
- Stork Test
- Examiner stands behind patient for support
- Patient balances on one leg and hyperextends back
- Positive if pain at affected lumbar Vertebrae
VI. Imaging: XRay
- Indicated for back pain lasting >3 weeks
- Views: AP, lateral and oblique views
- Findings: Scotty Dog Sign on oblique view
- Identify landmarks corresponding to Scotty Dog
- Head of Scotty Dog: Superior articular process
- Neck of Scotty Dog: Pars interarticularis
- Front leg of Scotty Dog: Inferior articular process
- Body and back leg of Dog: Transverse process
- Findings consistent with Spondylolysis
- Collar on Scotty Dog neck: Fracture through pars
- Identify landmarks corresponding to Scotty Dog
- Pitfalls
- Pars Fracture often not seen in early Spondylolysis
VII. Imaging: Advanced Imaging
- Single photon emission computed tomography (SPECT)
- Most sensitive for Spondylolysis
- Consider for nondiagnostic XRay
- CT L-S Spine (thin cut, reverse gantry CT)
- Highly specific for Spondylolysis
- Consider for positive SPECT scan
- Differentiates acute versus chronic Spondylolysis
VIII. Management
- Relative rest period with no sports activity
- Chronic Spondylolysis: Rest until no pain
- Acute Spondylolysis: Rest minimum of 3 months
- Adjunctive measures
- Bracing could be considered at 3 weeks of rest
- Consider repeat CT to survey acute injury for healing
- Rehabilitation program
- Spine stabilization (flexion, hamstring, core muscle)
- Low-impact aerobics
- Progress to sport-specific activity
IX. Management: Orthopedics or spine surgery referral indications
- Spondylolysis refractory to above management
X. Complications
XI. References
- Connolly (1995) Fractures and Dislocations, p. 443-4
- Cassas (2006) Am Fam Physician 73:1014-22 [PubMed]
- Standaert (2002) Clin J Sports Med 12:119-22 [PubMed]
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| Definition (MSH) | Deficient development or degeneration of a portion of the VERTEBRA, usually in the pars interarticularis (the bone bridge between the superior and inferior facet joints of the LUMBAR VERTEBRAE) leading to SPONDYLOLISTHESIS. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D013169 |
| ICD10 | M43.0 , M43.00, M43.09 |
| SnomedCT | 203688008, 240221008 |
| English | Spondylolyses, Spondylolysis, Spondylolysis [Disease/Finding], Spondylolysis, site unspecified, spondylolyses, spondylolysis, spondylolysis (diagnosis), Spondylolysis (disorder) |
| Japanese | 脊椎分離, ｾｷﾂｲﾌﾞﾝﾘ |
| Swedish | Spondylolys |
| Czech | spondylolýza, Spondylolýza |
| Finnish | Spondylolyysi |
| Russian | SPONDILOLIZ, SPONDILOZIS, СПОНДИЛОЗИС, СПОНДИЛОЛИЗ |
| Korean | 척추분리증 |
| Croatian | Not Translated[Spondylolysis] |
| Polish | Spondyloliza |
| Hungarian | Spondylolysis |
| Norwegian | Spondylolyse |
| Dutch | Spondylolyse, spondylolyse, Spondylolysis |
| Spanish | Espondilolisis, espondilólisis (trastorno), espondilólisis, Espondilólisis |
| French | Spondylolyse |
| German | Spondylolyse |
| Italian | Spondilolisi |
| Portuguese | Espondilólise |
