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Faqs About SpondylolysisBy Expert Author: Sejal Thakkar
What is spondylolysis?
Spondylolysis is a defect of the vertebrae. Stress fractures occur due to, or the issue leads to, weakening of muscles in that spinal region over a period of time. The area that undergoes a stress fracture is called the pars interarticularis. This defect is found in the pars interarticularis of the vertebral arch of the back bones. Often, a few individuals are born with this disorder. In the majority of such cases, though, this is found in the lower back rather than in the thoracic region. The occurrence of this spinal ailment is higher in athletes participating in:
How common is it?
More often than not, Spondylolysis is seen in more cases where children and young adults are involved when compared to old people. In case of the latter, it is found that the degenerative ailment is more common among the old people as they are far more susceptible to spine degeneration.
What are the symptoms for it?
The lower back is responsible for carrying out most of the weight. Along with bearing weight, the lower spine also is believed to absorb most of the directional pressures as well. One who is suffering from this disorder is likely to experience pain in buttocks as well as in thighs. Stiffness in the back is also a very common symptom in spondylolysis. Along with that, the tightening of hamstring muscles or localized tenderness over the pelvis bone and on the spine can also be major symptoms. Few patients also experience difficulty in controlling bladder as well bowel functions.
• How will it be diagnosed?
The diagnosis is made by experts using a combination of:
1. Physical examination and history
2. Imaging studies such as X-rays, MRIs or a CAT scan.
3. Potentially a bone scan
It may be necessary to obtain a bone scan (dexa scan) as the exam and imaging studies may not definitively show the fracture. There is one particular view that is an oblique x-ray of the lumbar spine that is the best for seeing the fracture. In order to see if the spondylolysis is actively trying to heal the bone scan may help there too. If it lights up on a bone scan then you know that the patient's bone is actively trying to heal itself. Also, a Digital Spine Analysis Test (DSA) accurately identifies the location and degree to which the stress fracture has weakened the muscles in the injured area. With this report, the injured spinal muscles and ligaments can be identified and the treatment protocol can be designed to strengthen them. This not only helps treat the condition but also reduces the chances of reoccurrence.
• What treatments are available for it?
The non-surgical options are:
Bracing: A brace is placed as a support. An anti-lordotic brace is recommended for patients unable to adjust with the pain.
Hydrotherapy: this treatment is used in early injury repair as the weight of the body is reduced due to the buoyancy of water. Relaxed freestyle or hydrotherapy exercises causes restricted movement without much pain. Another alternative is water running to maintain a cardiovascular fitness.
Strengthening Normal Muscle Strength and Coordination: once the pain and inflammation is settled down, your back joints that take part in motion and posture will be gently exercised. This is done reduce the stiffness from lack of movement. This is done to reduce the load on the pars interarticularis stress. This will also include leg and back muscles. These muscles will be stretched to allow normal movement. The deep abdominal core muscles provide three stages of muscle firing, that is, deep, intermediate and superficial, where the latter indicates normal pain – free backs.
Back Pain Core Stabilisation Program: this program assist in regaining normal core muscle control, by assessing the recruitment pattern of the muscles. The best exercise is then prescribes especially for your needs.
Pilates: this exercise regime is used to understand the postures that can further damage your spondylolysis, and carefully try and avoid it
Surgical options can be used for effective treatment of Spondylolysis as well. In most cases, though, there is no need for them.
Posterior Lumbar Fusion: This is a spinal fusion surgery, where you would fuse two vertebrae together. This surgery enters the patient’s body from back side and completely fuses the defected vertebrae.
Laminectomy: This surgery removes the bony rings of the vertebrae and releases the pressure. The release of this pressure eases the nerve compression in Radiculopathy or Cauda equina syndrome, which in turn can be caused by the progressive nature of the degenerative changes of this ailment.
Dr Sejal Thakkar, A Spine Consultant at Qi Spine Clinic, a Masters in Musculoskeletal Conditions from Nanavati hospital and Bachlors of Physiotherapy from D.Y.Patil college of Physiotherapy, Certified Shacklock's Neurodynamic solutions and Mulligan's technique of mobilisation. Pursuing certification in MDT (Mechanical Diagnosis and treatment) from the Mckenzie Institute, New Zealand
She is driven by the goal of achieving excellence in clinical practice by constantly updating my knowledge and has a special interest in movement analysis and done several workshops on Kinetic Control-Movement solutions, Spondylosis treatment solutions.
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