Diagnostic Testing for Spondylolysis
Diagnostic TestingPars defect can cause symptoms that may mimic other spine conditions. The spine specialists at Och Spine at NewYork-Presbyterian may take the following steps to find out what is causing your symptoms and determine if you have spondylolysis of the cervical or lumbar spine. They will also decide whether it is unilateral (affecting one side of a vertebra) or bilateral (affecting both sides):
- Medical history to learn about your symptoms: when did they start, what makes them feel better or worse, and how do they limit your activities? The doctor will also ask you about your family medical history and your activities.
- Physical and neurological exams to assess your range of motion, muscle strength, pain, and sensation.
- Imaging exams such as X-rays, computed tomography (CT) scans, and/or magnetic resonance imaging (MRI), are helpful for showing the bones, discs, and nerves in and around your spine.
- Bone scan to see if the fracture is new or from an old injury.
- A diagnostic injection using a local anesthetic applied into the area of the pars interarticularis may be used to isolate the source of your pain and confirm or rule out spondylolysis.
Noninvasive Treatment for Spondylolysis
Noninvasive TreatmentMost people with spondylolysis do not undergo surgery but rather use nonsurgical approaches to help the fracture heal and/or relieve pars defect symptoms. Our physicians try these techniques first to see if they can help you feel better.
Rest from physical activity
Your doctor may advise you to take a break from physical activity for a few weeks to allow the fracture to heal, which can take 6-12 weeks. The length of time you need to rest will depend on what caused your fracture and can vary depending on its severity and overall health.
Physical therapy
Physical therapy for spondylolysis is a common treatment approach. Physical therapists help patients learn about proper alignment of the spine and methods to move safely while teaching ways to improve strength, posture, range of motion, and flexibility. Components of physical therapy may include exercises you learn with your therapist and do at home to stretch and strengthen your muscles. Your therapist will choose the exercises that are most effective for you.
Exercises
Pars defect exercises typically focus on stretching and core strength. Your doctor or physical therapist will let you know which ones are most likely to be effective for treating spondylolysis.
- Stretching exercises may include knee extensions and stretching of the neck, hamstrings (back of the thighs), quads (front of thighs), hips, and chest muscles.
- Strengthening exercises target the back, abdominal, and hip muscles.
- Cardiovascular exercises will be gradually introduced as healing continues and may include stationary cycling, jogging, and water exercises.
Back braces
A back brace may enhance your recovery from spondylolysis. It immobilizes the part of your upper or lower spine with the pars defect and allows it to heal, especially if resting on its own is not helping you to feel better. The brace may also provide support during physical therapy. A lumbar back brace may be used to prevent the lower back from developing unusual curves during the healing process. You may need to wear the brace for several weeks; the brace will be custom-made to fit you.
Medications
Over-the-counter and prescription medications may be used to relieve spondylolysis pain. The medication recommended by your doctor will depend on the type, location, duration, and severity of your back pain. These medications include:
- Acetaminophen
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen
- Prescription anti-inflammatory drugs or muscle relaxants (if muscle spasms are present); gabapentin or pregabalin may be prescribed for nerve pain
Spondylolysis Surgery
SurgerySurgery is not a common treatment for spondylolysis, but it may be needed when nonsurgical therapies are not sufficient for relieving pars defect symptoms.
- Pars defect repair may be performed to stabilize the fractured portion of a vertebra, using metallic screws, hooks, or wires and sometimes a piece of bone from another part of the body (bone graft) to help the two pieces of bone to join together. This procedure is most often done in people under age 25.
- Spinal fusion unites two vertebrae using metal instruments and sometimes a bone graft. It is a type of surgery sometimes used in older adults with painful spondylolysis and in those with nearby spinal disc degeneration. The fusion provides support, keeps the bones from moving against each other, and maintains a good amount of space in the spinal canal, preventing narrowing (stenosis).
When to See a Doctor for Spondylolysis
When to See a DoctorYou should see a doctor if your spondylolysis symptoms persist or worsen, particularly if they prevent you from being as mobile as you would like. Also, see a doctor if you experience numbness, tingling, or bladder or bowel problems (indicating a nerve may be affected). You can try many approaches to treat pars defect and its symptoms.
Receive Personalized Spine Care at Och Spine at NewYork-Presbyterian
Spondylolysis is a fracture of the spine that can affect people of all ages. Thanks to advances in spine care, there are many techniques your doctor can recommend to help you feel better.
Every doctor at Och Spine has experience in various back and neck conditions and injuries. When you call us to make an appointment, we will work with you to identify the best physician for your specific need.
At Och Spine, we'll isolate the cause of your discomfort and customize a plan of care to meet your personal needs.
Give us a call to make an appointment for a consultation.