pathology: spondylolysis / spondylolysis interarticularis / isthmus defect / isthmus dysplasia

yogabook / pathologie / spondylolysis

spondylolysis

Unilateral or bilateral formation of fissures or fractures in the pars interarticularis (isthmus) of a vertebral arch, first described in 1782. These occur as fatigue fractures. The disease affects about 4% of all boys in the 6th year of life and about 6% of all men in adulthood. The disease usually manifests itself between the 7th and 8th year of life. As the hip joints are more flexed in childhood, greater force is exerted on the vertebrae and especially the isthmuses, weakening and possibly damaging them. The incidence is about half as high in women. There are clear ethnic and regional differences, with prevalence varying between 1% (Black) and 54% (Eskimos). The L5/S1 segment is most frequently affected (82%), followed by L4/L5 (11%). According to Wiltke, spondylolysis is divided into types:

1: congenital or dysplastic
– Axial alignment of the articular processes
– sagittal alignment of the articular processes
– other congenital anomalies
2: isthmic
– Lysis in the pars interarticularis
– Lysis in the pars interarticularis with secondary elongation of the pars interarticularis
– Acute fracture of the pars interarticularis
3: degenerative
4: traumatic with localization other than pars interarticularis
5: pathological
6: post-op

Of these types, degenerative type 3 is the most common. In the Marchetti-Bartolozzi classification, a distinction is made between congenital and acquired.
If spondylolisthesis occurs due to fracture of the interarticular pars, this is referred to as isthmic.

Cause

  1. Multifactorial (genetic, endocrinological, mechanical)

Predisposing

  1. Sports that predispose to an increased development of a hollow back, such as apparatus gymnastics, ballet, dolphin swimming

Diagnosis

  1. X-ray

Symptoms

  1. between asymptomatic and manifest neurological symptoms
  2. Usually asymptomatic in childhood, increasing lumbar pain towards puberty, which increases with forceful exertion(flexion, extension of the spine), e.g. rowing, high diving. Usually improves quickly after the end of exertion
  3. Increased formation of a hollow back at a more advanced stage
  4. possibly pressure pain
  5. For acute complaints Stiffness of the back
  6. Shortening of the hamstrings and limited hip flexion
  7. Disc hernias and neuroradicular complaints are rare in children

Complications

  1. Spondylolisthesis
  2. Lumbalgia is of thymic, discogenic or muscular origin (mainly due to spinal canal stenosis in spondylolisthesis)
  3. Ischialgia affecting L5, more rarely S1; usually in advanced spondylosis with spondylolisthesis, which produces the symptoms of spinal canal stenosis or cauda equina syndrome

Therapy

  1. Infiltration with NSAIDs for specific back pain
  2. In the case of fresh spondylosis in childhood or early adolescence, orthosis if necessary
  3. Exercise therapy with strengthening of the muscles(autochthonous and abdominal muscles), anti-inflammatory exercises
  4. Under certain circumstances, reconstruction of the vertebral arches, possibly fusion of the lumbosacral junction (stiffening L5-S1)