Spondylolisthesis and S in Aaletes

DAWD J, PmU%LWDM$ m9 A% SCS CORE Network, LLC Pittsburgh, Pennsylvania

4- Participation sentation of spondylolysis and spondylolisthesis in order to design 7 \ i- in competitive appropriate treatment intervention. ' 1 sports carries in- Sponc lylogeni c disord ers P 91 11 herent risk. Most 1 n~ rnp Lumt7ar spine ar athletic activities require an ath- e of low1 lete to perform rapid complex le adole movements, many of which pro- *.3 The vertebral column is a seg- duce compressive, torsional, and mented structure comprising 33 - Athlel tes with these di bC) I - shear stresses on the lumbar .-. 3. vertebrae. Collectively, the articu- ders oltten complain of spine. I?1 lower back pa ii that lated vertebrae provide increased Athletes who participate in mobility to the trunk and protec- contact and collision sports may ~tedinsi . diously and increases with. .lumbar . tion to the spinal cord and exiting have even greater loads applied neural structures. spine extensic to the lumbar region due to po- I presex The anterior vertebral body is tential impact with other athletes Treatr nent inv olves re primarily cancellous bone sur- ----: 2 -- - C 1----- 1 and the playing surface. The high dVVlU\-.- rounded by a thin layer of corti- forces from a single traumatic extens $ion/ tru nk stren gth- cal bone (Williams & Warwick, event can produce serious lower ening exercise IS,and a n 1986). The large lumbar vertebral 1 ... back pathology, but it is believed asls on maintaming a bodies allow weight-bearing that cumulative repetitive stresses positior forces to be transmitted along the from sports participation are re- vertebral column. Each vertebral sponsible for most lower back body articulates with the neigh- complaints (Berry et al., 1994). boring vertebral bodies superiorly In gymnastics, 12 to 19% of all This article is intended to give and inferiorly through interverte- injuries are to the trunk and spine, athletic trainers and therapists a bra1 discs (Moore, 1992; Williams whereas the incidence of spinal better understanding of spondy- & Warwick, 1986). injuries across all sports has been logenic disorders in athletes. It re- The posterior portion of each reported at 20% (Cypress, 1983; views the pertinent anatomy, vertebra is called the vertebral McAuley et al., 1997)._Low-back - provides an overview of the etiol- - arch. It is primarily composed of dysfunction can be a challenging ogy and suggested mechanisms of cortical bone and serves an an dilemma for the athlete as well as injury, and presents preventive attachment site for multiple mus- for the individual providing reha- strategies. Hopefully, readers will cles and ligaments (Williams & bilitative care. Jearn to recognize the clinical pre- Wanvick, 1986).

0 1999 Human Kinetics March 1999 The pedicles are a dense and tebral body, in relation to the strong dorsal projection off the vertebrae below, is called spon- vertebral body. The two pedicles dylolisthesis. In approximately project posteriorly and join the 80% of patients with spondyloly- lamina medially, the superior ar- sis, some anterior translation of ticulating process superiorly and the vertebral body, spondylolis- the pars interarticularis inferiorly. thesis, was found with radio- The lamina project dorsally graphic imaging (Saraste, 1993). and medially and join to form the It is believed that disruption spinous process. The joining of the of the pars interarticularis in- lamina closes an osseous ring that creases the shear load on the in- will protect the spinal cord and tervertebral disc at the involved spinal nerves. level, resulting in spondylolisthe- The posterior vertebral arches sis (Payne & Ogilvie, 1996). The of adjacent vertebrae articulate exact mechanism for anterior dis- through bilateral facet joints placement of the vertebral body which are created by respective is not fully understood, but long- superior and inferior articulating term follow-up studies have surfaces (Moore, 1992; Williams & shown that progression of the dis- PHOTO 1 Stork test. Warwick, 1986). The pars inter- placement is rare (Saraste, 1993; articularis is continuous with the Stinson, 1996). despite the fact that it often does inferior articulating surface, and It appears that the athlete's not heal completely. Immobiliza- is thin and vulnerable to injury in symptoms are related to the de- tion in a cast or brace is often ef- the adolescent athlete who has gree of anterior displacement of fective at reducing symptoms and not reached skeletal maturity the vertebral body (Saraste, 1993). improving function, but radio- (Stinson, 1996). Early detection and intervention graphic union is often unattain- are important in assuring a favor- able (Stinson, 1996). Failure of able prognosis for return to sports. radiographic union alone should Spondylolysis and spondylo- not keep an athlete from return- Spondylolysis is defined as a dis- listhesis have three major char- ing to sports (Hoshina, 1980; ruption in the pars interarticularis acteristic differences when com- Stinson, 1996). of the posterior vertebral arch. It pared to stress fractures that Finally, there is a strong ge- is often described as a fatigue or occur in other parts of the body. netic component related to spon- stress fracture. Spondylolysis can Unlike other stress fractures, the dylogenic disorders. Adolescents occur at any vertebral level, but defect of the pars interarticularis of Alaskan Eskimo descent have is most common in the lower is an acquired condition that de- the highest incidence of pars de- lumbar region (Dubousset, 1997). velops in young people. There is fects, whereas adolescents of Af- Some 90% of patients with spon- a high incidence of spondylolysis rican American descent have the dylolysis have involvement at in athletes 5 to 15 years of age lowest (Hoshina, 1980). With this the 5th lumbar level (Saraste, (Stinson, 1996). pathology, family history is an 1993). In a study by Micheli and important variable when inter- The pars interarticularis acts Wood (1995), 47% of athletes un- viewing an athlete about his or as a fulcrum point for hyperexten- der the age of 19 with complaints her lower back pain. sion of the lumbar spine. It also of lower back pain had spondy- Young athletes whose sports has a small area of focused stress, lolysis. Only 5% of athletes over involve repetitive hyperextension less than 1 cm2, making the pars the age of 21 with lower back pain of the lumbar spine appear to be interarticularis susceptible to this had spondylolysis. The diagnosis at greatest risk for developing type of stress fracture (Stinson, of spondylolysis was confirmed spondylolysis and spondylolis- 1996). through imaging studies. thesis. The essential components Spondylolysis with an ante- Second, in some cases the of a competitive gymnastics rior slippage of the involved ver- pars defect may be asymptomatic routine place high loads on the

March 1999 The Pmfes islornal Jsurnal for Athletia: Tmlrners an