So far we have described the anatomy of the vertebra, the location of a pars fracture/spondylolysis, how it develops, and how we can diagnose it. Now we will discuss how to treat a pars fracture/spondylolysis.
As mentioned in an earlier post
the main symptom is low back pain, which typically increases with
sporting/athletic activities, and may also interfere with activities of daily
living (i.e. attending school, sitting, etc…). So, a major part of treatment is
to minimize or eliminate low back pain.
How do we treat the low back pain from a pars fracture/spondylolysis?
1.
Limitation of activities:
This means the avoiding activities (as much as possible) which make the back pain
worse, such as sports/athletic activities.
2.
Pain medications: In
general, medications for pain control should be limited to over-the-counter acetaminophen. Infrequently have we employed the use of a
Pain Service, an anesthesiology-driven service who have expertise in pain
medication, for individuals with more severe pain which interferes with
activities of daily living.
3.
Physiotherapy:
Strengthening of the paraspinal back muscles and core musculature can be
helpful in decreasing low back pain.
4.
Bracing: use a rigid
flexion lumbosacral orthosis (LSO) may be beneficial, especially when the pars
fracture/spondylolysis is relatively new.
If prescribed it is usually worn for 3 months. Flexible low back braces have been advocated,
with some literature support, however they are rarely recommended for patients
seen in our clinic.
Will the pars fracture/spondylolysis heal with bone? Acute pars fractures/spondylolysis may heal with
bone. However, we don’t know if bony
healing is necessary for pain relief.
All that may be needed is a fibrous connection or scar tissue to fill
the area and make it stable enough to mitigate the pain. So, rather than worrying about bony healing,
the definition of success is the elimination of pain.
How long can nonsurgical treatment be continued? There really is no
limit to how long one can limit activities, use acetaminophen, and perform low
back strengthening. The amount of pain
and how it interferes with activities is unique for each individual.
When should nonsurgical treatment be stopped and surgery
should be performed? Since the amount of low back pain varies
significantly it really depends on each individual’s perspective. How does the pain interfere with activities
of daily living? Or sports/athletic activities?
How frustrated is the individual in their inability to do the activities
they enjoy? These are all questions
which need to be answered by individuals with pars fractures/spondylolysis
It is relatively common the
surgery is not wanted by individuals/parents when they are in 8th-11th
grades. This is because if they choose
to do surgery the individual will be out of sports/athletic activities for 6
months after surgery. This can
significantly disrupt different sports seasons.
We will continue to present this topic over the next several
posts, with the next post discussing surgical treatments.