Spondylosis

General Information

Description:

  • Stress fracture of the pars interarticularis


Definitions:

  • Spondylosis = ankylosis (bony fusion) of the vertebra, but term often applied non-specifically to any degenerative lesion of spine
  • Spondylolysis = dissolution of pars interarticularis
  • Spondylolisthesis = forward movement (displacement) of one vertebra in relation to adjacent vertebra


Organs involved:

  • Pars interarticularis of vertebra, 90-95% at L5-S1, 75% bilateral


Who is most affected:

  • Symptoms in adulthood, onset usually 5-7 years and painless for familial form


Incidence/Prevalence:

  • 4.4-6% in general population, common only in young athletes in activities requiring repetitive extension


Causes and Risk Factors

Causes:

  • Stress fracture


Likely risk factors:

  • Spondylolysis among elite athletes more common in throwing sports, artistic gymnastics and rowing, based on series of 3,152 elite athletes (Am J Sports Med 2000 Jan-Feb;28(1):57 in Phys Sportsmed 2001 Jan;29(1):5)


Complications and Associated Conditions

Complications:

  • Prolonged bilateral symptoms could lead to spondylolisthesis
  • Lumbar spine x-ray abnormalities associated with low back pain in high school and college football players; 6 lumbar spine x-ray views were taken in 171 high school and 742 college football players for evaluation of 6 abnormalities, follow-up 1 year for low back pain symptoms; incidence of low back pain was 49-54% with at least 1 radiographic abnormality, 32-37% with no abnormalities, 80% with spondylolysis, 60-70% with disk-space narrowing, 54-62% with spinal instability, 50-55% with Schmorl node, 45-50% with balloon disk, and 40-45% with spina bifida occulta AM J Sports Med 2004 Apr-May;32(3):781 in J Musculoskel Med 2004 Oct;21(10):559)


Associated conditions:

  • spina bifida occulta 13 times more common


History and Physical

History:

Chief concern (CC):

  • Low back pain


History of present illness (HPI):

  • Pain unilateral at belt line, without radiation
  • Aggravated by extension, standing or activity, relieved by rest


Family history (FH):

  • 27%-69% familial incidence (vs. 4.4-6% in general population)


Social history (SH):

  • Gymnasts, ballet dancers, football linemen


Physical:

General physical:

  • Pain reproduced if patient stands on one leg (affected side) and arches back
  • May have scissors gait with advanced cervical spondylosis
  • Sperling’s sign (extension of neck with slight rotation) suggests cervical spondylosis

 


1 view


1 view


0 views