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Transcript of Caused by a defect in the pars interarticularis without any displacement. Degeneration of vertebra,...
![Page 1: Caused by a defect in the pars interarticularis without any displacement. Degeneration of vertebra, affecting intervertebral discs Indicates a fusion.](https://reader030.fdocuments.in/reader030/viewer/2022032705/56649dba5503460f94aab06d/html5/thumbnails/1.jpg)
Spondylolisis
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definition
Caused by a defect in the pars interarticularis without any displacement.
Degeneration of vertebra, affecting intervertebral discs
Indicates a fusion of vertebrae and immobilisation.
Can cause spondylolisthesis.
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Definition ( Continued)
Pars interarticularis=between lamina & inferior facet underneath the pedicle and superior facet above; joins adjacent facet joints of the spine.
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Patho-physiology
Narrowing of vertebral column and area between pars articularis.
Defect in continuity of vertebral bodies
Bridged by fibrous tissue Potential mechanical instability Mechanical stress to the neural
arch Osseous defect bridged by
connective tissue and cartilage Exert pressure on nerve root.
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Patho-physiology (Continued)
Repetitive mechanical stress- hyperextension & trunk rotation
Mostly fatigue #’s→ repetitive stress & load
Greatest load with flex/ext movement at L5/S1
↓ acute pars #’s in older people→ ↑ in neural arch strength (4th-5th decade)
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Causes & risk factors
Congenital defect Genetic predisposition Direct trauma to the isthmus with
non-adhesion Indirect trauma with a stress
fracture Possible weakness in pars
interarticularis Condition: asymptomatic or slight
to severe pain in lower back ↑ incidence in athletes- gymnasts &
football.
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Causes & risk factors ( Continued) Incidence varies according to
ethnicity, sex, sports activity, family history, occupation & relevant diseases.
Relevant diseases= spina bifida occulta, osteoporosis, osteogenesis imperfecta, cerebral palsy, Scheuermann’s disease & scoliosis.
Repetitive mechanical stress.
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Causes & risk factors ( Continued) Athletes at Risk
(Sport): Gymnasts Divers Offensive linemen in
football Pole vaulters Weight lifters Wrestlers Dancers High jumpers
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Signs and symptoms
Incidence: 6% of general population
Common in adolescents
Present without any obvious symptoms
Pain with hyperextension Pain increases- starts with sport,
present in ADL’s and eventually interferes with sleep.
Hyperlordotic lower back Tightness of hamstring mm.
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Signs and symptoms (continued)
Aching lower back, usually unilateral which localises around belt area.
May feel like a m. strain Back stiffness No nerve root pain Symptoms eased by rest
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Special tests
Standing one-legged hyperextension test:
Stand on the leg of the same side on which there is pain (i.e., if the pain is on the right side, stand on your right leg). Then, gently lean backwards. If the pain is reproduced, this may be a positive sign for spondylolysis.
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Diagnosis
The doctor will perform a physical exam.
Diagnosis is also based upon clinical history
An X-ray of the lower back can show any fractured vertebra.
CT scan or MRI to detect very small fractures.
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Medical management
Early diagnosis is important
Rest Mobilise joints for pain relief:
PA grade 2 for pain Lumbar rotations grade 4- for
pain Relieve muscle spasm Strengthen postural muscles –
lumbar & abdominal stabilisers Mobilise lumbar fascia
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Medical management ( Continued)
Muscle stretches – short spinal mm.,hamstrings Home advice regarding sport → be cautious Corset – Boston brace Trigger points Massage Cross training that is done pain-free Anti-inflammatory medication Electrical stimulation – heal bone
Surgery: Spinal fusion between lumbar vertebra & sacrum
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Preventions of Spondylolysis Injury
Support lower back b.m.o maintaining abdominal & back stabilisers
Do activities that do not place stress on the lower back
Avoid over-exercising Maintain a good posture Kinetic handling Good back support – sit for long
periods
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X-rays
“Scotty-dog” Ears shaped by superior facet Face by transverse process Eye is one pedicle Legs shaped by inferior facet Body shaped by lamina Tail and hind legs by opposite facet With defect, collar around neck.
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X-ray
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X-ray
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Article
Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain
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Article
Objective: To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back pain.
Aim: establish the prevalence of lumbar spondylolysis in the general adult population and to evaluate whether there was a significant correlation between age and prevalence.
Few studies have demonstrated the significance/ prevalence of spondylolysis in adults.
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Article
Population: adults older than 20 years; went for an abdominal or pelvis CT scan. Exclude patients that had a CT scan for low back pain. Separated into age into different decades. 2 555 evaluated, 203 positive cases 8% prevalence.
Where: United States, July 2008- November 2008.
Made us of Multi-detector Computed Tomography(MDCT)
Images reviewed by radiologists.
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Article
Conclusion: No significant ↑ in prevalence in patients older than 20
years. Symptomatic lumbar pars defects do not occur in this
population Treatable cause of low back pain. Study failed to support hypothesis that lumbar
spondylolysis ↑ with age. Male:female 1,5:1.
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References
Barnes,R.2011.NEUROMUSCULAR-SKELETAL REHABILITATION DICTATE.(Unpublished dictate.) University of the Free State , Free State.
Asher, A. 2008. Spondylolysis. (http://backandneck.about.com/od/conditions/p/Spondylosis.htm)
Retrieved on 1 September 2012.
Plone Foundation. 2007. Physical Therapy Corner: Spondylolisthesis and Spondylolysis in Gymnasts. (http://www.nismat.org/ptcor/spondylo)
Retrieved on 3 September 2012.
Where In City. 2011. Spondylolysis Injury. (http://www.whereincity.com/medical/topic/back-and-neck/diseases/spondylolysis-injury-102.htm)
Retrieved on 3 September 2012.
Standaert, CJ and Herring, SA. 2000. Spondylolysis: a critical review. British Journal of Sports Medicine 34:415-422.
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References
Cluett, J. 2011. Spondylolysis. (http://orthopedics.about.com/cs/spondylosis/g/spondylolysis.htm)
Retrieved on 1 September 2012.
Asher,A. 2005. Spondylolysis Definition. (http://backandneck.about.com/od/s/g/spondylosis.htm)
Retrieved on 1 September 2012.
Spine-health.com. 2012. Spondylolysis Definition. (http://www.spine-health.com/glossary/s/spondylolysis)
Retrieved on 3 September 2012.
Brooks KB, Southam SL, Mlady GW, Logan J and Rosett M. 2009. Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain. Skeletal Radiology (2010) 39:669-673.