Spondylolysis, also known as a pars defect, happens when a crack forms in the bony ring on the back of the spinal column. Most commonly, this occurs in the lumbar spine. In this condition, the bone that protects the spinal canal fractures as a result of excessive or repeated stress. Patients can also be born with a congenital defect in this area and develop symptoms much later in life when this area is injured.
The condition mainly affects young athletes who participate in sports in which the spine is subject to repetitive extension, such as gymnastics, football, and karate. Although pars defect can affect people of any age, children and adolescents are most susceptible. This is because their spines are still developing, and the pars is the weakest part of the vertebra. Placing extra strain on this area of the spine during childhood increases the chance that a pars defect will occur.
Naturally, the vertebra’s initial response to the abnormal strain is to add new bone cells surrounding the injured area. But, if the injuries happen faster than the body can keep up, a crack may form in the weakened bone. This is called a stress fracture. The most common location for this to occur is in the lower lumbar spine at the L5 level. However, a problem with the pars can occur at any lumbar vertebra. Very rarely it occurs in two places simultaneously.
Symptoms of a pars defect are pain and stiffness in the center of the low back. Lumbar extension and twisting typically increases pain. Symptoms get worse with activity and go away with rest. Some may experience pain radiating down one or both legs. This pain comes from pressure and irritation on the nerves that exit the spinal canal near the fracture. Patients can even experience numbness, tingling, and weakness in their legs.
Most patients with pars defect do not require surgery and can experience relief with medications and rest. Anti-inflammatory medications and muscle relaxers are commonly used to treat pain. Often, a lumbar corset back brace is prescribed for the acute phase of the injury. Physical therapy is also initiated once diagnosed. Once PT begins, the therapist will introduce a series of strengthening exercise for the abdominal and low back muscles. Working these core muscles helps patients begin moving easier and lessens the chances of future pain and problems. Patients typically need to attend therapy sessions for 6-8 weeks and should expect full recovery to take up to 6 months. In more severe cases of pain, steroid spinal injections may help. When symptoms are not relieved with nonsurgical treatments patients may require surgery. Surgical options for a pars defect include a pars repair versus a lumbar fusion.
If you are experiencing back or leg pain, and think you may have a pars defect, please call for an appointment today or request an appointment online.