Spondylolysis

Clinicians in the Orthopedic Center at Children’s Hospital Boston have extensive experience treating adolescents with overuse injuries such as spondylolysis. Our collaborative approach allows us to us to provide more accurate diagnosis and prompt and effective treatment.

What is spondylolysis?

Spondylolysis is a stress fracture that occurs in the lower back:

• A stress fracture is a type of overuse injury, or an injury that occurs when trauma is repetitively placed on the same part of the body.

• In spondylolysis, repetitive trauma is placed on the lower back. This repetitive trauma causes a crack to form in the lower back, usually nearthe lowest of the lumbar vertebrae.

Who is at risk for getting spondylolysis?

Spondylolysis is commonly found in children and teenagers who play sports that place a lot of stress on the lower back or involve a constant over-stretching (hyperextending) of the spine.

The sports that put adolescents at the highest risk for spondylolysis are:

• diving
• gymnastics
• football (particularly for offensive linemen)
• rowing

Are there any medical complications associated with spondylolysis?

If fractures don’t heal properly, spondylolysis can progress to spondylolisthesis: a condition in which one or more vertebrae slip out of place and slide past each other.

• Spondylolisthesis is more common in children who developed spondylolysis early on in life rather than repetitive-use athletes.

• Symptoms include lower back pain and tight hamstrings.

• Treatment for spondylolisthesis depends on the severity of symptoms. Rest, physical therapy and back braces are used in mild cases, while more severe cases are treated with surgery.

Causes

What causes spondylolysis?

Some children have a genetic predisposition to developing spondylolysis and acquire a crack in their backs by the age of  5 or 6. These children usually have no signs or symptoms and are only diagnosed when they get an x-ray for another problem.

When symptomatic, spondylolysis is more commonly caused by overuse. An overuse injury happens when too much stress is continuously placed on a single part of the body. When this stress occurs repeatedly over time, the body's muscles don’t have time to recover and become unable to absorb the shock of impact. As a result, the stress load transfers to the bone instead.

Symptoms

What are the symptoms of spondylolysis?

Many children who are born with a genetic predisposition to spondylolysis have no symptoms and don’t even know they have the condition. Symptoms usually occur in adolescents who participate in sports that place a lot of stress on the lower back.

• The most significant symptom of spondylolysis is pain that spreads across the lower back and worsens when a child leans backwards. The pain tends to progress in stages:

• At first, the child may only experience mild pain while playing sports.

• As repetitive trauma continues, the pain becomes more constant.

• Eventually, the child will experience constant pain in his lower back, even when he’s not playing sports.

• Tight hamstrings are also common in adolescents with spondylolysis.

What is the long-term outlook for a child with spondylolysis?

Overuse injuries heal very quickly in children and adolescents. However, it’s important that children follow the activity restrictions and strengthening rehabilitation program put in place by their doctors. Most children with spondylolysis can return to regular activities after a few months of rest and healing time. If there is a risk of re-injury, the doctor may recommend that the child avoid certain sports.

Questions to ask your doctor

If your child has been diagnosed with spondylolysis, you probably already have some ideas and questions on your mind, but it can be easy to forget the questions you wanted to ask when you’re talking to your child’s doctor. It’s often helpful to jot them down ahead of time to make sure that all your concerns have been addressed.

Some questions you might want to ask include:

• Will there be restrictions on my child’s activities? If so, for how long?
• Will my child’s spondylolysis cause any permanent damage?
• How does Children’s treat stress fractures?
• Should my child return to playing sports?