Bilateral Spondylolysis:

Bilateral Spondylolysis: Symptoms, Causes, Diagnosis and Treatment

September 20, 2020

There’s a chance that you’ve never come across this big medical term before. Well, the big word spondylolysis simply means back stress fracture. So whenever you come across this word just know that it’s simply back stress fracture. This means that the back fracture in this condition is simply caused by stress. Certain strenuous activities would cause this condition. We will take a look at them. That way you would know which strenuous activity you are doing right now that can increase your risk of having this condition. Also, this condition can be unilateral or bilateral. But our focus is mainly bilateral spondylolysis.

Some symptoms accompany this condition. Just in case you have these symptoms then there’s a chance that you have this condition already. And you may have to go see a doctor as soon as you can. There are methods by which the doctor can diagnose the condition as well. We will take a look at them. And lastly, we will be taking a look at possible treatment options for the patient. So that you would have an idea of what your doctor would recommend for you as a treatment option. Well, without wasting any more time let’s take a look at all these things briefly.

 

What is Bilateral Spondylolysis?

This is a condition where there is a fracture in the back caused by stress. This is commonly seen in children, adolescents, and also young adults. Another name for this condition is a pars stress fracture. About 90-95% of cases are known to occur at the L5 vertebra. Usually, stress lesions would heal completely. But then again in about 25% of the cases, there is fracture nonunion.

There are different classifications for this condition. It could either be dysplastic which is caused by congenital problems such as in spina bifida. And then isthmic which is stress fracture gotten as a result of the sport. Then there is degenerative which happens in older adults as a result of conditions such as arthritis. It could also be caused by trauma. The most common among all these happen to be isthmic.

A condition that could happen from spondylolysis is spondylolisthesis. This happens when spondylolysis becomes worse and then the vertebral body goes forward. This occurs in about 50% of the cases. This is commonly seen among people that have bilateral spondylolysis and females.

  • People with this condition have the following symptoms.
  • Sharp unilateral back pain that occurs suddenly and then becomes dull later
  • The pain becomes worse with standing and stress
  • When at rest the pain subsides
  • The pain radiates to the thigh and buttocks
  • The hamstrings become tight and the back arch is exaggerated
  • Normal neurological signs

Causes

Some activities are known to affect the back. Many of these activities come with hyperextension and repetitive rotation. And this could lead to fractures.

These are some of the sports that can cause this condition:

  • Gymnastics
  • Wrestling
  • Cricket bowlers
  • Weightlifting
  • Diving
  • Ice skating
  • Butterfly swimming
  • Golf
  • Ballet dancing
  • Track and field especially throwers like shotput and javelin
  • Gridiron

With continuous repetition of some of the activities listed above the chances of having this condition greatly increases.

 

Diagnosis

The diagnosis of this condition comes with a lot of things. It starts with the symptoms of the patient. And then the physical examination is done. Then X-rays of the spine are done, and this is used to evaluate the patient. Also, a SPECT bone scan is carried out. This is sensitive for picking up if a patient has an active disease or not. When bone scintigraphy is done as well this would help tell if a patient has an acute condition caused by a chronic problem.

When the physical exam is done the most common finding happens to be low back pain. As well as pain that comes with the extension of the back. Also, hamstring tightness if commonly seen.

Most of the patients have no neurological symptoms and then the pain does not go past the back. So it would be rare to find a patient with referred pain to the leg.

 

Treatment

When it comes to treating this condition the treatment at first is conservative. And the aim is facilitating healing as well as reducing the pain. Let’s look at some of the treatment options that doctors opt for.

  • Managing inflammation and pain: One of the main reasons why people with this condition seek help is because of pain. So the doctor tries to first manage the inflammation that is causing pain. The work of the physiotherapist would be to help reduce pain using some tools. One way you help reduce inflammation is to reduce the activity that causes inflammation.
  • Back brace: This is another option that can be opted for. And this is used for people that the pain does not reduce quickly.
  • Hydrotherapy: This is quite useful in the early stages. And that’s because there is less bodyweight. After all, there is a lot of water in the body. So you would be able to move freely without causing so much pain.
  • Restoring joint range: If pain and inflammation are reduced, your therapist will focus on restoring your range of motion and posture. There are times that some joints associated with the condition would be stiff, and this would need mobilizing to set them back in motion.
  • Return to sport: After the pain has reduced and the inflammation has reduced, the next thing is getting you back to the sport. So the physiotherapist would aim to get you back right on track. Your sports physiotherapist would be in the best position to get you back on that field. But you can surely expect that there would be changes when it comes to techniques and your schedule. This is to reduce the risk of this recurring again.

 

The good news is that bilateral spondylolysis can resolve within 6-12 weeks. Many times conservative treatments are all you need. So you wouldn’t have to quit sports for life if you have this condition. Just think of it as taking a break. Well, that’s about it for spondylolysis.