Spondylolysis – type congenital or acquired defect in the area of the vertebral arch. What this disease is? The cause of congenital abnormalities is the disruption of the formation of certain parts of the spine, and acquired in the presence of regular overloads in the back.
Fusion of the lumbar spine (l4-l5) is often asymptomatic in nature, sometimes accompanied by some degree of stiffness and pain in the lower back.
To clarify the diagnosis used methods of radiography, scintigraphy and computed tomography.
The reasons for the development and classification of spondylolis
What is spondylolysis? This is a defect in certain sections of the pedicles of the vertebra, are very well-known pathological condition. Young people up to 20 years the disease has affected in the same way as older (30 years) and does not depend on the gender of the person. Men have a higher risk of occurrence of disease than females.
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There is information confirming the existence of a genetic predisposition. The vast majority of cases, problems are observed in the lumbar region. At that most vulnerable of the 5th lumbar vertebra, much less 4th. There is a possibility of defeat at the same time l4 and l5 vertebrae.
Fusion of the lumbar spine in equal measure can be identified as people involved in sports and those who lead a not so active lifestyle. The exceptions are certain types of sports in gym class or rowing.
They spondylolysis is more common than other sporting events. This disease can cause pain in the back, but also become a factor contributing to the development of a disease such as spondylolisthesis (slippage of the upper vertebra forward, which sometimes occurs in combination with pinching the nerve roots and the appearance of sciatica). Thus, spondylolysis and spondylolisthesis – associated diseases.
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In the field of traumatology spondylolysis is divided into categories, starting from the conditions for the development of the disease, localization of the pathological condition and the clinical picture of the disease. For reasons of disease the disease is divided into:
- Congenital – incomplete bending of the vertebral arc, not due to the fusion of 2 nuclei of the bone. The presence of hereditary predisposition to the formation of the thin bone of the spine is the main cause of the pathological condition at the stage of fetal development. This disease becomes noticeable at the time of active formation of the musculoskeletal system.
- Purchased – the influence of environmental factors: the practice of regular high physical activity and low content of nutrients in consumed products for normal bone growth. Repeated functional overload of the vertebra without the initial pathological conditions are the major causes of fractures of the vertebral arch.
- Mixed – trauma or extra load on the background of existing dysplasia of the vertebral arch. Heavy physical exercise several times higher than the level of elasticity of bone tissue, often lead to their destruction.
The location of the pathology of the disease is:
- the typical pathology is located in the area of the interarticular gap;
- atypical – it is localized between the articular gap and the base arc;
- retrocognitions – pathology is located behind the vertebral body.
According to the clinical manifestations of pathologies of the disease is divided into:
- Asymptomatic spondylolysis l5 vertebra, characterized by the absence of pain.
- Disease with the presence of pain syndromes and a variety of painful symptoms.
- Disease, complicated pathologies with uncomfortable sensations in some areas of the waist, and a displacement of the vertebrae (spondylolysis and spondylolisthesis, arising almost at the same time). In this situation, determine the level of development of spondylolisthesis and the degree of displacement of vertebrae relative to the sacrum.
The area between the foot and the arch of the spine can be exposed to high physical impact during movement, the vertical movement of the cargo, sports. In the absence of adequate splice zone between the joints or the presence of a number of small injuries in normal bone tissues may develop certain physiological deviation in the lumbar region.
Proven effect of genetic predisposition on the onset and course of the disease. The original horizontal localization of the sacrum has an impact on subsequent bending of the body and arch of the 5th vertebra in the lumbar. This standard location of the vertebra can become a causal factor in additional load on the shackle, with further modification.
Symptoms and diagnosis
Patient find it difficult to identify spondylolysis and spondylolisthesis because the symptoms spondylolysis l5 vertebra and the displacement of the vertebrae in most of the situations are expressed softly. Patients complain of temporary pain of low intensity in the lower back. They often appear during the execution of physical activity, long stay in a sitting or prone position, prolonged walking, sudden waking up.
Exacerbation of unpleasant feelings can occur when making turns in different directions or in the exercise of tilting during extension of the spine. In rare cases, pain radiating into the buttock or thigh. Infrequently may develop pain syndromes that hinder physical activity.
Visually, the disease can be detected, examined the lumbar spine. In the presence of the disease curve of the lower back is excessive.
The disease is often complicated by the occurrence of spondylolisthesis (displacement of the upper vertebra forward) and sciatica (infringement of nerve endings). In many cases, spondylolysis and spondylolisthesis occur simultaneously.
To establish an accurate diagnosis applied radiography of the spine in the side, straight and 2 oblique projections. This examination enables detection of spondylolysis and spondylolisthesis in the early stages.
In addition, there are more accurate and sensitive diagnostic methods, namely scintigraphy and single photon emission tomography, during their conduct revealed accumulation of isotope in the area of the defect.
In certain situations a full description of the condition of a vertebra given the CT scan results back. They allow you to view spondylolysis and spondylolisthesis in the form of horizontal slices. The drawback of this method is the low accuracy in identifying the clinical significance and period of occurrence of defects.
Therapy most well-known types spondylolis – lesions of l4 and l5 is similar. The difference is noticeable only in the implementation of surgical intervention when there is a consolidation of various sections of the spine affected by the injury.
How to treat spondylolysis and spondylolisthesis? Informed patients are often recommended to limit physical activity, not to participate in the events. However, the information is based on modern diagnostic methods and the latest scientific research, suggests that it is not always necessary. Any restrictions of activities may be needed only in the case if any concerned. Relaxation during the holidays can help eliminate pain to the patient, which appears the chance to return to a normal life.
Although the restriction activity is not always advisable, it is recommended observation of such patients in the hospital. Non-surgical treatment options effective in 72% of patients in the early stage of the disease and during the active phase is only 37%. The active form spondylolysis requires surgery.
With this form of disease can be assigned reklamiruesh the wearing orthopedic corset with a duration of four months. It will provide the possibility of straightening of the lumbar spine. Before sleep, the corset is removed. At the same time may be prescribed nonsteroidal anti-inflammatory drugs, as well as drugs from the group of muscle relaxants. Recommended exercises for stretching the popliteal region with the slow increase in load.
If no result after conservative therapy for six months may be considered for surgical intervention with the goal of pursuing and strengthening of the lumbar spine. When bilateral type spondylolis there is also a need for the operation.
At the same time, doctors often perform a decompressive laminectomy, which allows to reduce the degree of irritation of the spinal cord. Strengthening the spine is also possible through the use of special medical pins, hooks, screws. Recovery after surgery takes place within a few months of therapy regimens inactive spondylolysis.