Obtaining a second opinion to objectively determine if a spondylolysis is amenable to conservative care is critical.


Spondylolysis refers to the existence of a bony defect or fracture within the posterior bony arch connecting one vertebra to the next.  This commonly will result in forward slippage of one vertebra relative to the one beneath it (spondylolisthesis).  The classic teaching of causation for spondylolysis has been that an individual is born with a weakness in this posterior bony arch, called the pars interarticularis, and at approximately age 6, a fatigue injury occurs that breaks this bony arch.  Later, in high school, with the weightlifting and contact stresses of football, or the extension stresses of gymnastics, or wrestling, the latent fracture is irritated and become symptomatic.


Another group of young individuals exist who present with an acute fracture.  These patients typically describe having sustained a significant hyperextension injury or compressive force to their lumbar spine, which is followed by the immediate and sudden onset of very severe low back pain.  X-rays may reveal a fresh fracture in the posterior bony arch, and these patients will also have a markedly positive bone scan.  Overall, these patients are in the minority of those diagnosed with spondylolysis, and they may require more aggressive treatment in the form of rigid bracing or surgical stabilization.


It is estimated that 5% of the general population exists with a spondylolysis that is completely asymptomatic.  As such, it is clear that not all identified spondylolytic defects require treatment.  Spondylolysis may be unilateral in up to one third of these patients.  With the seemingly increased intensity in high-school sports, there has seemed to be an epidemic of spondylolysis.  Up until recently, we have considered this condition to be a fairly routine problem.  More recently, with the use of CT scanning and single-photon emission computed tomography (SPECT) scanning, it has been found that the condition is far from routine, and it is difficult to be dogmatic with regard to the criteria for diagnosis and treatment.  For this reason, obtaining a second opinion to objectively determine if a spondylolysis is amenable to conservative care is critical.




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