Spondylolysis treatments

Clinical studies have found varying degrees of healing using conservative (non-surgical) treatments (such as bracing) ranging from 73% healing of early-stage spondylolysis versus 38% healing in those with progressive disease. One study of adolescent athletes found that 37% of them showed signs of healing at the pars defects after 2 to 6 months of bracing.(1)

• Bracing to immobilize the spine for a short period (e.g. four months) to allow the pars defect to heal

• Pain medications and/or anti-inflammatory medication, as needed

• Stretching, beginning with gentle hamstring stretching and progressing with additional stretches over time

• Exercise that is controlled and builds gradually over time, with restrictions on extension (bending backwards)

On rare occasions, spondylolysis that is not healing or may have neurological components can require surgery to provide internal fixation and stability to the area, and if necessary to reduce pressure on the nerves.

• Occasionally, a decompressive laminectomy may be needed to reduce pressure on the nerves in the area. This procedure tends to increase spinal instability.

• A spinal fusion may be needed to provide stabilization of the affected area of the spine.

If both a decompressive laminectomy and spinal fusion are needed, then both procedures are done as part of the same surgery.

Medical literature indicates that once the lesion has healed and becomes inactive, the likelihood of significant progression is minimal, and only rarely does the slippage require surgical intervention.

For discomfort or pain associated with chronic inactive spondylolysis, there are several treatment options available, including pain medications, physical therapy and exercise, and occasionally chiropractic or osteopathic manipulation.

For patients seeking chiropractic or osteopathic manipulation for this condition, it is important to note that there is no evidence in the medical literature that manipulation can reduce slippage or cause an active site to heal. But there are some case studies to show that manipulation will often provide temporary pain relief for the patient. This is because appropriate manipulation treatment can relieve many of the side effects of spondylolysis, such as lower back pain caused by stresses on various spinal structures, including the facet joints.

In general, most people with chronic inactive spondylolysis can find sufficient pain relief through a combination of conservative treatments, such as manual therapy, exercise, and lifestyle changes. However, it is important to note that any therapeutic approach must take into account that spondylolysis means that there is a potentially unstable area of the spine, so caution and the skill of the treating spine specialist are very important considerations.

By: Tom Hyde, DC, DACBSP
July 8, 2004

1. Bergmann TF, Hyde TE, Yochum TR. Active or Inactive Spondylolysis and/or Spondylolisthesis: What's the Real Cause of Back Pain? J Neuromusculoskel Syst. 2002:10:70-78.