SPONDYLOLYSIS

Spondylosis definition 

Pars interarticularis of L1, L2, L3, L4, or L5 is unilaterally or bilaterally disrupted.

Spondylolysis is generally due to a hyperextension stress fracture from extension activities.

Spondylolysis is the most common cause of spondylolisthesis.Most common in L5-S1.

The ICD-10 code for lumbar spondylosis is M47.16.

Mechanism of Injury

Repetitive microtrauma from shear, longitudinal loading, and hyperextension of the vertebral column.

Common in  athletes

Divers

Gymnasts

Wrestlers

Football 

Spondylosis symptoms

Recurrent dull ache, usually localized, which can be provoked by extension activities.

Low back pain

Tight hamstrings

Buttock pain

Scoliosis and tenderness.

Limited range of motion ( in backward extension )

Examination-

General review of trunk balance, alignment, and posture.

Tight hamstrings.

Phalen-Dickson sign – knee flexed, hip flexed gait.

Lumbosacral low back pain, increased by hyperextension

Radiographs

Oblique X-ray( “Scotty dog”)

CT

MRI

Differential diagnosis

Spondylolisthesis

Osteoid osteoma/osteoblastoma

Disk space infections

Muscle or neurologic disorders

Rheumatoid spondylitis

Complications

Fibrous union

malunion

nonunion

spondylolisthesis

spinal stenosis with neurogenic claudication.

Spondylosis treatment

A. Acute injury-Rest, including avoidance of all activities placing loading forces on the spine for 8 to 12 weeks. Use of a modified Boston brace may be required for up to 3 to 6 month.

B. Semi-acute injury

Rest, unloading, and immobilization with ambulatory antilordotic bracing (i.e., Boston)

Gradual (over 3 months), progressive return to activity follows, beginning with flexibility and strengthening exercises and concentrating on lumbosacral stabilization program. Return to play is allowed only after a symptom-free rehabilitation program is completed.

C. Chronic injury

Permanent avoidance of upright weight training (e.g., deadlifts,squats, snatch and jerk).  Surgical decompression or fusion appears to be no more effective than placebo or conservative treatment.

Prevention

A. Back retraining and abdominal muscle training (antilordotic exercises)

B. Preseason physical screening.

C. Job and sport profiling to avoid repetitive lumbar extension

There are several famous people who have been reported to have spondylosis. Some examples include:

1. Tiger Woods: The professional golfer has been open about his struggles with spondylosis, which has caused him significant back pain and required multiple surgeries.

2. Peyton Manning: The former NFL quarterback also dealt with spondylosis during his career, which contributed to his decision to retire in 2016.

3. Nancy Reagan: The former First Lady of the United States was known to have spondylosis, which caused her chronic back pain.