Spondylolysis is a stress fracture of the vertebra's pars interarticularis, which can lead to vertebral slippage and primarily affects young athletes, especially in sports requiring hyperextension. Symptoms include localized pain and restricted movement, typically relieved by rest, while diagnosis may involve imaging techniques like x-rays and SPECT scans. Management includes pain relief, cessation of aggravating activities, physical therapy, and in some cases, surgical intervention.

1. SPONDYLOLYSIS
PATEL.YASH.GIRISHBHAI

2. DEFINITION
 STRESS FRACTURE OF PARAS INTERARTICULARLS
 Spondylolysis is a unilateral or bilateral bony defect in the
pars interaticulris or isthmus of the vertebra.
 It can cause a slipping of the vertebra, in which case the term spondylitis
spondyloysthesis is used.

4. ETLOLOEY
 Affects 3-6% of population
 This condition appears in the first or second decade of life;
the frequency of spondyloyis increases with age until 20
years. There is, however, no change in prevalence with
increasing age from 20 to 80 years old.
 Men are affected twice as often as women.

5.  There is increased prevalence in specific ethnic. Sports and
family groups.
 Sponyloysis occurs more frequently in the young athletic
population.
 There is increased risk in gymnasts, football players,
cricketers, swimmers, divers, weight lifters and wrestlers.

6.  Spondylolysis is considered to be a stress fracture that result
from mechanical stress at the pars interatcualris
 These stress fractures occur due to repetitive load and
rather then being coursed by a single traumatic event
 Occurs mostly at L5 (80-95%):sue to repetitive
hyperextension, which increases the contact between the
caudal edge of the inferior articular facet of l4 and the pars
interarticularis

7. CLINICAL FEATURES
 Onset of pain
 Possible history of local trauma
 Intense pain restricts activities of daily or sporting
performance
 Symptoms become aggravated after a stressful event
 Rest usually relieves the symptoms

8. C/F LUMBAR SPONDYLOYSIS
 Focal low back pain with radiation into the buttock or thigh
with no neurological deficit.
 Children under 13 years old show tenderness or pain on
extension
 Children can present a posture deformity or abnormal gait
pattern.
 Pain throughout limber rang of movement

9. D/D
 Disc injury
 Lumbosacral discogenic pain syndrome
 Facet joint syndrome
 Acute bone injuries
 Sprain/strain injuries
 Spondylolisthesis
 Myofascial pain in athletes

10.  Sacroiliac joint injury
 Lumber radiculopathy
 Osteomyelitis
 Spinal stenosis

11. DIAGNOSTIC PROCEDURE
 SPECT (single photon emission computed tomography)
shows area of involvement
 X-ray shows area of involvement

15.  X-RAY
shows :
“ SCOTTISH DOG SIGN”

16. ON EXAMINATION
 Hyperlordotic posture
 Low back pain during lumber extension
 Para spinal muscle spasm and hamstring tightness is present
 Neurologic exam is usually normal but neurogenic
symptoms can arise if the condition progresses to
spondylisthesis

17. STROK TEST
 Performed to assess localised spondyloysis pain
 The patient stands on one leg with other foot resting on one
leg with other foot resting on the weight bearing knee.
 The patient then hyper extends the lower back
 Positive test: reproduction of lower back pain suggest limber
spondyloysis.

18. MEDICAL MANGMENT
 NSALDS to provide pain relief
 Cessation of aggregating activities
 The use of a spinal brace to prevent motion at the injured
pars and allow bony repair
 Physical therapy

19. SURGICAL TREATMENT
 May be required.
 This only occurs in some patients and evidence of long-term
benefit is still uncertain.
 Latest procedures attempt a repair of the affected pars with
preservation of the segmental mobility whereas earlier
method sometimes included a spinal fusion procedure.

21. PHYSICAL THERAPY MANGMENT
GOALS
 Reduce pain
 Promoting normal movement patterns
 Global and specific strengthening exercises
 Optimization of physical function

22.  A rehabilitation program should progress in four stages:
 Control pain and inflammation
 Strength and flexibility
 Stabilization
 Functional movement

23. Control pain and inflammation
 Deep heating modalities: for pain relief
 Taking stress off the injured area allows physiological healing
processes to take place.
 It may be necessary to avoid rotational shearing forces and
extension movements by a temporary cessation of sporting
activities / wearing a brace.

24. Strength and flexibility
 Exercises to improve relaxation and aenral mobility of spine
are initiated first.
 As para spinal muscle spasms and hamstrings tightness are
often seen in patient can be added to the rehabilitation
program.
 Flexibility training is useful in patient with hypermobility of
the spine.

25. Functional movement
 The main goal of physiotherapy is to increase functional
abilities through a home exercise program.
 As soon as primary pain decreases, patient have to be
encouraged to resume activities as tolerated.