- Symptoms are more often noted in younger patients
and include localized back pain. - An acute onset of pain and tight hamstrings can be
associated with a worse outcome (d’Hemecourt et al,
2002). - When there is a bilateral spondylolysis there can be
anterior slippage of the vertebral body on the adja-
cent vertebral body and this is known as spondylolis-
thesis.
•With respect to spondylolisthesis, this is more com-
monly seen in males and is located at the L5 vertebral
body level, followed by L4, and then L3. - Spondylolisthesis can result in compression of the
nerve roots and present as radicular pain and/or with
neurologic deficits.
•Meyerding’s classification is useful for grading
spondylolisthesis displacement: ( 1 ) less than 25%,
( 2 ) 25–50%, ( 3 ) 50–75%, and ( 4 ) greater than 75%
displacement. - On physical examination there is often an associated
increase in the lumbar lordosis, decreased range of
motion, and tight hamstrings. - The diagnosis of spondylolysis is often confirmed
with radiographs utilizing lateral and oblique views to
demonstrate a break in the neck or collar of the
“Scottie Dog.” - Bone scan with spectmay be necessary to confirm a
more difficult diagnosis. - The diagnosis of spondylolisthesis may be confirmed
with flexion and extension radiographs that will help
to determine segmental instability.
•Treatment of these entities can be controversial, how-
ever, and may involve the use of a brace, corset, or
custom molded body jacket, and therapy emphasizing
abdominal strengthening and flexion based exercises. - Athletes with symptomatic spondylolysis who are
treated with an anti-lordotic brace may be able to
expect improvement and possible return to sports
participation in 4–6 weeks (d’Hemecourt et al,
2002). - In particular, Morita found that when pars defects
were found early, with conservative management,
(rest and lumbosacral corset for 3–6 months) healing
was produced in 73% of the patients versus 38.5% of
progressive and 0% of terminal defects (Morita et al,
1995).
•Patients with neurologic symptoms as a result of their
injury may require surgical intervention.
LUMBAR SPINAL STENOSIS
- Please refer to the section titled Thoracic Spinal
Stenosis.
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