spondyloysis introduction investigation treatment physiotherapy treatment this is used full in physiotherapy student and mbbs student

1. SPONDYLOLYSIS
PATEL.YASH.GIRISHBHAI

2. DEFINITION
 STRESS FRACTURE OF PARAS INTERARTICULARLS
 Spondylolysis is a unilateral or bilateral bony defect in the
pars interaticulris or isthmus of the vertebra.
 It can cause a slipping of the vertebra, in which case the term spondylitis
spondyloysthesis is used.

4. ETLOLOEY
 Affects 3-6% of population
 This condition appears in the first or second decade of life;
the frequency of spondyloyis increases with age until 20
years. There is, however, no change in prevalence with
increasing age from 20 to 80 years old.
 Men are affected twice as often as women.

5.  There is increased prevalence in specific ethnic. Sports and
family groups.
 Sponyloysis occurs more frequently in the young athletic
population.
 There is increased risk in gymnasts, football players,
cricketers, swimmers, divers, weight lifters and wrestlers.

6.  Spondylolysis is considered to be a stress fracture that result
from mechanical stress at the pars interatcualris
 These stress fractures occur due to repetitive load and
rather then being coursed by a single traumatic event
 Occurs mostly at L5 (80-95%):sue to repetitive
hyperextension, which increases the contact between the
caudal edge of the inferior articular facet of l4 and the pars
interarticularis

7. CLINICAL FEATURES
 Onset of pain
 Possible history of local trauma
 Intense pain restricts activities of daily or sporting
performance
 Symptoms become aggravated after a stressful event
 Rest usually relieves the symptoms

8. C/F LUMBAR SPONDYLOYSIS
 Focal low back pain with radiation into the buttock or thigh
with no neurological deficit.
 Children under 13 years old show tenderness or pain on
extension
 Children can present a posture deformity or abnormal gait
pattern.
 Pain throughout limber rang of movement

9. D/D
 Disc injury
 Lumbosacral discogenic pain syndrome
 Facet joint syndrome
 Acute bone injuries
 Sprain/strain injuries
 Spondylolisthesis
 Myofascial pain in athletes

10.  Sacroiliac joint injury
 Lumber radiculopathy
 Osteomyelitis
 Spinal stenosis

11. DIAGNOSTIC PROCEDURE
 SPECT (single photon emission computed tomography)
shows area of involvement
 X-ray shows area of involvement

15.  X-RAY
shows :
“ SCOTTISH DOG SIGN”

16. ON EXAMINATION
 Hyperlordotic posture
 Low back pain during lumber extension
 Para spinal muscle spasm and hamstring tightness is present
 Neurologic exam is usually normal but neurogenic
symptoms can arise if the condition progresses to
spondylisthesis

17. STROK TEST
 Performed to assess localised spondyloysis pain
 The patient stands on one leg with other foot resting on one
leg with other foot resting on the weight bearing knee.
 The patient then hyper extends the lower back
 Positive test: reproduction of lower back pain suggest limber
spondyloysis.

18. MEDICAL MANGMENT
 NSALDS to provide pain relief
 Cessation of aggregating activities
 The use of a spinal brace to prevent motion at the injured
pars and allow bony repair
 Physical therapy

19. SURGICAL TREATMENT
 May be required.
 This only occurs in some patients and evidence of long-term
benefit is still uncertain.
 Latest procedures attempt a repair of the affected pars with
preservation of the segmental mobility whereas earlier
method sometimes included a spinal fusion procedure.

21. PHYSICAL THERAPY MANGMENT
GOALS
 Reduce pain
 Promoting normal movement patterns
 Global and specific strengthening exercises
 Optimization of physical function

22.  A rehabilitation program should progress in four stages:
 Control pain and inflammation
 Strength and flexibility
 Stabilization
 Functional movement

23. Control pain and inflammation
 Deep heating modalities: for pain relief
 Taking stress off the injured area allows physiological healing
processes to take place.
 It may be necessary to avoid rotational shearing forces and
extension movements by a temporary cessation of sporting
activities / wearing a brace.

24. Strength and flexibility
 Exercises to improve relaxation and aenral mobility of spine
are initiated first.
 As para spinal muscle spasms and hamstrings tightness are
often seen in patient can be added to the rehabilitation
program.
 Flexibility training is useful in patient with hypermobility of
the spine.

25. Functional movement
 The main goal of physiotherapy is to increase functional
abilities through a home exercise program.
 As soon as primary pain decreases, patient have to be
encouraged to resume activities as tolerated.