Our vertebrae have a complex structure, in which the main body( corpus vertebrae) and arcs( arcus vertebrae) are distinguished. A defect in which the arc has a non-intersectional part is called spondylolysis. In other words, it is a fatigue fracture, most often appearing in people who engage in sports. The habitual place of its localization is the fifth lumbar vertebra, a little less often the fourth.
This disease occurs quite often( from 3 to 9% of the population).Constant over-extension of the spine in the lower back leads to the appearance of this pathology in athletes who are engaged in gymnastics, diving, wrestling and weightlifting, rowing and American football. For boys and girls under the age of 20, he appears about equally often, and at the older age more men suffer. In addition, a hereditary predisposition has been identified.
Table of contents:
- Causes and conditions of the onset of
- disease. How does the disease manifest itself?
- Diagnosis of spondylolysis
- How is
treated? Causes and conditions of the disease
The exact causes of spondylolysis are unknown, but the etiology can be divided into three categories:
- congenital, when there is no fusion of two ossification nuclei forming half the arc;
- acquired - the cause is excessive load and vertebral dysplasia or lack of nutritional bone tissue;
- mixed - when both factors are present.
In the early period, the disease is a zone of bone restructuring, and when the force load begins to exceed the elasticity of bone tissue, a fracture occurs in the critical place - in the interarticular zone of the arch. But this independent disease is reversible, i.e. With the elimination of force, a complete fusion of the fracture is entirely possible. Approximately half of the cases are associated with complications such as spondylolisthesis( slipping of the vertebrae).
disease manifests The main symptoms of spondylolysis are pain in the lumbar region. It may not be very strong, but resistant. Or rather intense, which can change the gait and limit movement. But this does not always happen. Sometimes the symptoms of the disease are generally absent, and the disease progresses. A characteristic feature of this pathology is increased pain when loins are loosened, and with tilts forward, it is weakened. Usually, pain is noted in the lumbar spine, but can extend to the buttocks or the back of the thigh. Sometimes patients complain of muscle tension behind the hip and restriction of movements in the lower back. Athletes often complain that they can not lie on their backs because of pain.
During the development of the disease, the body tries to replace the defect, and on the site of the fracture appear bony proliferation. They can press on the nerve roots, causing pain. In this case, the pain arises during movement, its character squeezing and giving in the leg.
Diagnosis of spondylolysis
First a physical examination is performed, although it is ineffective. With passive careful extension in the lower back, pain increases. The doctor conducts a provocative test: the patient, standing on one leg, should bend back. On the side of defeat with spondylolysis, the pain intensifies. Immediately, palpation is painful. X-ray of the vertebra in spondylolysis.
Further, when suspected of this ailment, X-rays in several projections and a picture of the lumbosacral joint are taken with a special direction of the radiation beam. Such pictures help in most cases to reveal the gap of spondylolysis in the interarticular part of the arc. In addition, the pictures show spondylolisthesis, if any.
There are also special diagnostic methods for athletes. If the X-ray did not show obvious defects, and the patient's complaints and physical examination still give reason to suspect the presence of spondylolysis, then one-photon emission tomography is most often done. It has high sensitivity and specificity, which allows to determine the disease in the period of fatigue fracture.
Computed tomography is also more sensitive than X-rays, and shows an arc defect in horizontal sections. However, it is difficult to judge from it the limitation and significance of non-occurrence.
When an articular arc defect is present on an x-ray, bone scintigraphy is often required to assess the clinical significance of the defect. If isotope accumulation is not detected, then most likely, the complaints do not refer to spondylolysis.
How to treat
At the first attacks of acute pain, conservative treatment is prescribed. Usually it is bed rest and local heat. Non-steroidal anti-inflammatory drugs are used, and muscle relaxants are used to relieve a strong muscle spasm. After relieving painful attacks, treatment is reduced to gymnastics, which strengthens the muscular corset. Do exercises with flexion and to strengthen the muscles of the abdominal wall.
If the athlete has complaints not only for back pain, but also more severe neurologic manifestations, and the radiography showed a defect in the interarticular part of the arc, then sports loads should be discontinued. Immobilization of the spine with a corset is also prescribed. The duration is up to eight weeks. At the same time the corset is worn in the daytime, at night it is allowed to take off.
If an athlete on an X-ray shows signs of spondylolysis, but no complaints, treatment is not required and he can continue training. If there are minor pain in the lower back, the treatment is to strengthen the muscles and maintain a good physical shape.
Short-term immobilization of the spine and restriction of loads in more than 90% of cases gives positive results.
Surgical treatment is required very rarely, becauseconservative methods are quite effective. This happens if the pain is persecuted by an athlete for more than six months.
Osteosynthesis of the interarticular part of the arc is done with the help of wire hooks, screws and pins. A bone graft is also used. After the failure of the defect, a course of rehabilitation is carried out.
- Pain in the sacrum