Spondylolysis

Spondylolysis is a spinal condition in which a small stress fracture or defect develops in one of the vertebrae, usually in the lower back. Spondylolysis is one of the most common causes of lower back pain in young athletes, particularly those involved in sports with repeated back bending or twisting. With early treatment, most people recover fully and return to their normal activities without long-term complications.

What Causes Spondylolysis?

Spondylolysis usually results from repeated stress on the spine rather than a single injury. Over time, the stress creates a small crack in the vertebra. It most often affects the thin portion of bone called the pars interarticularis, which connects the different parts of the vertebra.

Common causes and risk factors include:

• Repetitive hyperextension of the back (seen in gymnastics, football, diving, weightlifting)
• Overuse injuries from sports or high-impact activities
• Genetic predisposition—some people are born with thinner bone in the pars interarticularis
• Rapid growth during adolescence, which puts added stress on the spine
• Trauma or sudden spinal injury

What Are the Symptoms?

Some people with spondylolysis have no symptoms. When symptoms do occur, they may include:

• Lower back pain, often worsened by activity or extension (arching backward)
• Stiffness and reduced flexibility in the lower back
• Pain radiating to the buttocks or thighs
• Hamstring tightness
• Pain that improves with rest but worsens with sports or strenuous activity

When Should I See a Specialist About Spondylolysis?

You should see a spine or orthopedic specialist if you experience:

• Persistent lower back pain lasting more than a few weeks
• Pain that interferes with sports, school, or daily activities
• Stiffness or reduced flexibility that limits movement
• A history of sports injuries with recurring back pain
• Sudden worsening of pain after a fall or accident

Early diagnosis is important to prevent progression to spondylolisthesis (slippage of one vertebra over another).

How Is Spondylolysis Diagnosed?

To diagnose spondylolysis, a spine specialist will:

• Medical history and review of activity patterns
• Physical exam to test flexibility, tenderness, and movement
• X-rays of the lower spine to look for fractures in the pars interarticularis
• MRI or CT scans to detect smaller fractures or stress reactions not visible on X-ray

How Is Spondylolysis Treated?

Most cases can be treated successfully without surgery.

Nonsurgical Treatments

• Rest and avoidance of sports or activities that stress the back
• Nonsteroidal anti-inflammatory medications (NSAIDs) for pain relief
• Physical therapy to strengthen core and back muscles and improve flexibility
• Bracing in some cases to limit spinal movement during healing
• Gradual return to sports after symptoms improve and strength is restored

Most young athletes recover within 3 to 6 months of nonsurgical treatment.

Surgical Treatments

Surgery is rarely needed, but may be considered if:

• Pain persists despite several months of nonsurgical care
• The fracture does not heal and causes chronic symptoms
• Spondylolysis progresses to spondylolisthesis with nerve compression

Surgical options include:

• Pars repair: Fixing the fractured bone with screws or a bone graft
• Spinal fusion: Stabilizing the affected vertebra if instability is severe

What Are the Risks of Spondylolysis Surgery?

Possible risks include:

• Infection
• Nerve injury (rare)
• Failure of bone to heal (nonunion)
• Persistent pain or stiffness

What Does Recovery Involve?

Recovery typically includes:

• Short-term rest followed by structured physical therapy
• Gradual return to low-impact activity before resuming sports
• Avoiding hyperextension, twisting, or heavy lifting until cleared by your doctor
• Ongoing exercises to strengthen the core and support the spine

How Long Does Recovery Take?

• Nonsurgical care: 3 to 6 months for full return to sports
• Surgical repair or fusion: 6 months to a year, depending on healing and activity level

What Is the Outlook for Spondylolysis?

With proper care, most patients with spondylolysis recover fully and return to their usual activities, including competitive sports. Early treatment and physical therapy are key to preventing progression and ensuring long-term spinal health.