Pars Interarticularis Injury Medication

  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Apr 19, 2011
 

Medication Summary

Medications recommended for the treatment of pain in spondylolysis include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and muscle relaxants. Before prescribing these medications, review the contraindications, adverse side effects, and mode of action.

Next

Nonsteroidal Anti-inflammatory Drugs

Class Summary

NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. The mechanism of action of these agents is not known, but NSAIDs may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may include leukotriene synthesis inhibition, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation and various cell membrane functions.

View full drug information

Ibuprofen (Ibuprin, Motrin)

 

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. The anti-inflammatory dose is higher than the analgesic dose. Newer generation NSAIDs have a lower risk of gastrointestinal risk because they selectively interact with COX–2 receptors. Prolonged use of the medication is generally not recommended.

View full drug information

Celecoxib (Celebrex)

 

Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced by pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited, thus, GI toxicity may be decreased. Seek the lowest dose of celecoxib for each patient.

View full drug information

Naproxen (Naprosyn, Naprelan, Anaprox)

 

For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing the activity of COX, which is responsible for prostaglandin synthesis.

Previous
Next

Muscle Relaxants

Class Summary

Muscle relaxants help to relax tight muscles and can be used in conjunction with NSAIDs.

View full drug information

Cyclobenzaprine (Flexeril)

 

Muscle relaxants may be helpful in some patients with LBP and seem to have additional benefits when used in conjunction with NSAIDs. Muscle relaxants can be used as short-term adjunctive medications and should be taken hs to take advantage of their sedating side effects.

Previous
Next

Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who have sustained trauma or who have sustained injuries.

View full drug information

Acetaminophen (Tylenol, Feverall, Tempra)

 

Offers pain relief without the increased risk of bleeding for patients with contraindications to the use of NSAIDs.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Gerard A Malanga, MD  Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching

Coauthor(s)

David L Tung, MD, MPH  Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey

Disclosure: Nothing to disclose.

Nancy Kim, MD  Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey

Nancy Kim, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chris Perez, MD  Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey

Chris Perez, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew L Sherman, MD, MS  Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, University of Miami, Leonard A Miller School of Medicine

Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Pfizer Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Henry T Goitz, MD  Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

  1. Debnath UK, Freeman BJ, Grevitt MP, et al. Clinical outcome of symptomatic unilateral stress injuries of the lumbar pars interarticularis. Spine. Apr 20 2007;32(9):995-1000. [Medline].

  2. Olsen TL, Anderson RL, Dearwater SR, Kriska AM, Cauley JA, Aaron DJ, et al. The epidemiology of low back pain in an adolescent population. Am J Public Health. Apr 1992;82(4):606-8. [Medline]. [Full Text].

  3. Garry JP, McShane J. Lumbar spondylolysis in adolescent athletes. J Fam Pract. Aug 1998;47(2):145-9. [Medline].

  4. Hu SS, Tribus CB, Diab M, Ghanayem AJ. Spondylolisthesis and spondylolysis. Instr Course Lect. 2008;57:431-45. [Medline].

  5. Standaert CJ, Herring SA. Spondylolysis: a critical review. Br J Sports Med. Dec 2000;34(6):415-22. [Medline].

  6. Wu SS, Lee CH, Chen PQ. Operative repair of symptomatic spondylolysis following a positive response to diagnostic pars injection. J Spinal Disord. Feb 1999;12(1):10-6. [Medline].

  7. Roche MA, Rowe GG. The incidence of separate neural arch and coincident bone variations: A survey of 4200 skeletons. Anat Rec. 1951;109:233-52.

  8. Eisenstein S. Spondylolysis. A skeletal investigation of two population groups. J Bone Joint Surg Br. Nov 1978;60-B(4):488-94. [Medline]. [Full Text].

  9. Beutler WJ, Fredrickson BE, Murtland A, et al. The natural history of spondylolysis and spondylolisthesis: 45-year follow-up evaluation. Spine. May 15 2003;28(10):1027-35; discussion 1035. [Medline].

  10. Micheli LJ, Wood R. Back pain in young athletes. Significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med. Jan 1995;149(1):15-8. [Medline].

  11. Morita T, Ikata T, Katoh S, Miyake R. Lumbar spondylolysis in children and adolescents. J Bone Joint Surg Br. Jul 1995;77(4):620-5. [Medline]. [Full Text].

  12. Duggleby T, Kumar S. Epidemiology of juvenile low back pain: a review. Disabil Rehabil. Dec 1997;19(12):505-12. [Medline].

  13. Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. Jun 1984;66(5):699-707. [Medline]. [Full Text].

  14. Wiltse LL. The etiology of spondylolisthesis. J Bone Joint Surg Am. Apr 1962;44-A:539-60. [Medline]. [Full Text].

  15. Bell DF, Ehrlich MG, Zaleske DJ. Brace treatment for symptomatic spondylolisthesis. Clin Orthop Relat Res. Nov 1988;236:192-8. [Medline].

  16. Hoshina H. Spondylolysis in athletes. Phys Sportsmed. 1980;8(9):75-9.

  17. Ogilvie JW, Sherman J. Spondylolysis in Scheuermann's disease. Spine. Apr 1987;12(3):251-3. [Medline].

  18. Saraste H. Long-term clinical and radiological follow-up of spondylolysis and spondylolisthesis. J Pediatr Orthop. Nov-Dec 1987;7(6):631-8. [Medline].

  19. Wiltse LL, Newman PH, Macnab I. Classification of spondylolysis and spondylolisthesis. Clin Orthop Relat Res. Jun 1976;117:23-9. [Medline].

  20. Smith JA, Hu SS. Management of spondylolysis and spondylolisthesis in the pediatric and adolescent population. Orthop Clin North Am. Jul 1999;30(3):487-99, ix. [Medline].

  21. Blanda J, Bethem D, Moats W, Lew M. Defects of pars interarticularis in athletes: a protocol for nonoperative treatment. J Spinal Disord. Oct 1993;6(5):406-11. [Medline].

  22. Phalen G, Dickson J. Spondylolisthesis and tight hamstrings. J Bone Joint Surg Am. 1961;43:505-12. [Full Text].

  23. Wiltse LL, Widell EH Jr, Jackson DW. Fatigue fracture: the basic lesion is inthmic spondylolisthesis. J Bone Joint Surg Am. Jan 1975;57(1):17-22. [Medline]. [Full Text].

  24. Rosenberg NJ, Bargar WL, Friedman B. The incidence of spondylolysis and spondylolisthesis in nonambulatory patients. Spine. Jan-Feb 1981;6(1):35-8. [Medline].

  25. Dietrich M, Kurowski P. The importance of mechanical factors in the etiology of spondylolysis. A model analysis of loads and stresses in human lumbar spine. Spine. Jul-Aug 1985;10(6):532-42. [Medline].

  26. Cyron BM, Hutton WC. The fatigue strength of the lumbar neural arch in spondylolysis. J Bone Joint Surg Br. May 1978;60-B(2):234-8. [Medline]. [Full Text].

  27. Gregory PL, Batt ME, Kerslake RW, Scammell BE, Webb JF. The value of combining single photon emission computerised tomography and computerised tomography in the investigation of spondylolysis. Eur Spine J. Oct 2004;13(6):503-9. [Medline].

  28. Green TP, Allvey JC, Adams MA. Spondylolysis. Bending of the inferior articular processes of lumbar vertebrae during simulated spinal movements. Spine. Dec 1 1994;19(23):2683-91. [Medline].

  29. Letts M, Smallman T, Afanasiev R, Gouw G. Fracture of the pars interarticularis in adolescent athletes: a clinical-biomechanical analysis. J Pediatr Orthop. Jan-Feb 1986;6(1):40-6. [Medline].

  30. Edelson JG, Nathan H. Nerve root compression in spondylolysis and spondylolisthesis. J Bone Joint Surg Br. Aug 1986;68(4):596-9. [Medline]. [Full Text].

  31. Eisenstein SM, Ashton IK, Roberts S, et al. Innervation of the spondylolysis "ligament". Spine. Apr 15 1994;19(8):912-6. [Medline].

  32. Nordstrom D, Santavirta S, Seitsalo S, et al. Symptomatic lumbar spondylolysis. Neuroimmunologic studies. Spine. Dec 15 1994;19(24):2752-8. [Medline].

  33. Hasegawa S, Yamamoto H, Morisawa Y, Michinaka Y. A study of mechanoreceptors in fibrocartilage masses in the defect of pars interarticularis. J Orthop Sci. 1999;4(6):413-20. [Medline].

  34. Aland C, Rineberg BA, Malberg M, Fried SH. Fracture of the pedicle of the fourth lumbar vertebra associated with contralateral spondylolysis. Report of a case. J Bone Joint Surg Am. Dec 1986;68(9):1454-5. [Medline]. [Full Text].

  35. Pierce ME. Spondylolysis: what does this mean? A review. Australas Radiol. Nov 1987;31(4):391-4. [Medline].

  36. Amato M, Totty WG, Gilula LA. Spondylolysis of the lumbar spine: demonstration of defects and laminal fragmentation. Radiology. Dec 1984;153(3):627-9. [Medline]. [Full Text].

  37. Lowe J, Schachner E, Hirschberg E, Shapiro Y, Libson E. Significance of bone scintigraphy in symptomatic spondylolysis. Spine. Sep 1984;9(6):653-5. [Medline].

  38. Bodner RJ, Heyman S, Drummond DS, Gregg JR. The use of single photon emission computed tomography (SPECT) in the diagnosis of low-back pain in young patients. Spine. Oct 1988;13(10):1155-60. [Medline].

  39. Bellah RD, Summerville DA, Treves ST, Micheli LJ. Low-back pain in adolescent athletes: detection of stress injury to the pars interarticularis with SPECT. Radiology. Aug 1991;180(2):509-12. [Medline]. [Full Text].

  40. Itoh K, Hashimoto T, Shigenobu K, Yamane S, Tamaki N. Bone SPET of symptomatic lumbar spondylolysis. Nucl Med Commun. May 1996;17(5):389-96. [Medline].

  41. Herring SA, Standaert CJ. The spine in sports: re-evaluating the diagnostic assessment and treatment of spondylolysis in the young athlete. SpineLine. 2001;1:16-20.

  42. Dutton JA, Hughes SP, Peters AM. SPECT in the management of patients with back pain and spondylolysis. Clin Nucl Med. Feb 2000;25(2):93-6. [Medline].

  43. Harvey CJ, Richenberg JL, Saifuddin A, Wolman RL. The radiological investigation of lumbar spondylolysis. Clin Radiol. Oct 1998;53(10):723-8. [Medline].

  44. Congeni J, McCulloch J, Swanson K. Lumbar spondylolysis. A study of natural progression in athletes. Am J Sports Med. Mar-Apr 1997;25(2):248-53. [Medline].

  45. Yamane T, Yoshida T, Mimatsu K. Early diagnosis of lumbar spondylolysis by MRI. J Bone Joint Surg Br. Sep 1993;75(5):764-8. [Medline]. [Full Text].

  46. Maurer M, Soder RB, Baldisserotto M. Spine abnormalities depicted by magnetic resonance imaging in adolescent rowers. Am J Sports Med. Feb 2011;39(2):392-7. [Medline].

  47. King HA. Back pain in children. Orthop Clin North Am. Jul 1999;30(3):467-74, ix. [Medline].

  48. Seitsalo S, Osterman K, Hyvãrinen H, et al. Progression of spondylolisthesis in children and adolescents. A long-term follow-up of 272 patients. Spine. Apr 1991;16(4):417-21. [Medline].

  49. Steiner ME, Micheli LJ. Treatment of symptomatic spondylolysis and spondylolisthesis with the modified Boston brace. Spine. Dec 1985;10(10):937-43. [Medline].

  50. Ikata T, Miyake R, Katoh S, Morita T, Murase M. Pathogenesis of sports-related spondylolisthesis in adolescents. Radiographic and magnetic resonance imaging study. Am J Sports Med. Jan-Feb 1996;24(1):94-8. [Medline].

  51. Pizzutillo PD, Hummer CD 3rd. Nonoperative treatment for painful adolescent spondylolysis or spondylolisthesis. J Pediatr Orthop. Sep-Oct 1989;9(5):538-40. [Medline].

  52. Pettine KA, Salib RM, Walker SG. External electrical stimulation and bracing for treatment of spondylolysis. A case report. Spine. Mar 15 1993;18(4):436-9. [Medline].

  53. Micheli LJ, Hall JE, Miller ME. Use of modified Boston brace for back injuries in athletes. Am J Sports Med. Sep-Oct 1980;8(5):351-6. [Medline].

  54. Jackson DW, Wiltse LL, Dingeman RD, Hayes M. Stress reactions involving the pars interarticularis in young athletes. Am J Sports Med. Sep-Oct 1981;9(5):304-12. [Medline].

  55. Axelsson P, Johnsson R, Strömqvist B. Effect of lumbar orthosis on intervertebral mobility. A roentgen stereophotogrammetric analysis. Spine. Jun 1992;17(6):678-81. [Medline].

  56. Lantz SA, Schultz AB. Lumbar spine orthosis wearing. I. Restriction of gross body motions. Spine. Oct 1986;11(8):834-7. [Medline].

  57. Willems PC, Nienhuis B, Sietsma M, van der Schaaf DB, Pavlov PW. The effect of a plaster cast on lumbosacral joint motion. An in vivo assessment with precision motion analysis system. Spine. Jun 1 1997;22(11):1229-34. [Medline].

  58. Miller SF, Congeni J, Swanson K. Long-term functional and anatomical follow-up of early detected spondylolysis in young athletes. Am J Sports Med. Jun 2004;32(4):928-33. [Medline].

  59. Ciullo JV, Jackson DW. Pars interarticularis stress reaction, spondylolysis, and spondylolisthesis in gymnasts. Clin Sports Med. Jan 1985;4(1):95-110. [Medline].

  60. Sairyo K, Sakai T, Yasui N. Minimally invasive technique for direct repair of pars interarticularis defects in adults using a percutaneous pedicle screw and hook-rod system. J Neurosurg Spine. May 2009;10(5):492-5. [Medline].

  61. Stasinopoulos D. Treatment of spondylolysis with external electrical stimulation in young athletes: a critical literature review. Br J Sports Med. Jun 2004;38(3):352-4. [Medline]. [Full Text].

  62. Kaul MP, Herring SA. Rehabilitation of lumbar spine injuries in sports. Phys Med Rehabil Clin N Am. 1994;5(1):133-56.

  63. Hald RD. Dance injuries. Prim Care. Jun 1992;19(2):393-411. [Medline].

  64. Steele VA, White JA. Injury prediction in female gymnasts. Br J Sports Med. Mar 1986;20(1):31-3. [Medline]. [Full Text].

  65. Nadler SF, Malanga GA, DePrince M, Stitik TP, Feinberg JH. The relationship between lower extremity injury, low back pain, and hip muscle strength in male and female collegiate athletes. Clin J Sport Med. Apr 2000;10(2):89-97. [Medline].

  66. Nadler SF, Wu KD, Galski T, Feinberg JH. Low back pain in college athletes. A prospective study correlating lower extremity overuse or acquired ligamentous laxity with low back pain. Spine. Apr 1 1998;23(7):828-33. [Medline].

  67. Hollinshead WH, Rosse C. Lower limb. Textbook of Anatomy. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1986:678-81.

  68. Basmajian JV, DeLuca CJ. Lower limb. In: Basmajian JV, DeLuca CJ, eds. Muscles Alive: Their Functions Revealed by Electromyography. 5th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1985:310-5.

  69. Kujala UM, Salminen JJ, Taimela S, Oksanen A, Jaakkola L. Subject characteristics and low back pain in young athletes and nonathletes. Med Sci Sports Exerc. Jun 1992;24(6):627-32. [Medline].

  70. Hoch AZ. The female athlete: what's new? Presented at: Annual Meeting of the American Academy of Pediatrics; 2001; San Francisco, Calif.

  71. Omey ML, Micheli LJ, Gerbino PG 2nd. Idiopathic scoliosis and spondylolysis in the female athlete. Tips for treatment. Clin Orthop Relat Res. Mar 2000;372:74-84. [Medline].

  72. Dubousset J. Treatment of spondylolysis and spondylolisthesis in children and adolescents. Clin Orthop Relat Res. Apr 1997;337:77-85. [Medline].

  73. Pedersen AK, Hagen R. Spondylolysis and spondylolisthesis. Treatment by internal fixation and bone-grafting of the defect. J Bone Joint Surg Am. Jan 1988;70(1):15-24. [Medline]. [Full Text].

  74. Roca J, Moretta D, Fuster S, Roca A. Direct repair of spondylolysis. Clin Orthop Relat Res. Sep 1989;246:86-91. [Medline].

  75. Morscher E, Gerber B, Fasel J. Surgical treatment of spondylolisthesis by bone grafting and direct stabilization of spondylolysis by means of a hook screw. Arch Orthop Trauma Surg. 1984;103(3):175-8. [Medline].

  76. Newton PO, Johnston CE 2nd. Analysis and treatment of poor outcomes following in situ arthrodesis in adolescent spondylolisthesis. J Pediatr Orthop. Nov-Dec 1997;17(6):754-61. [Medline].

  77. Wiltse LL, Jackson DW. Treatment of spondylolisthesis and spondylolysis in children. Clin Orthop Relat Res. Jun 1976;117:92-100. [Medline].

  78. Szypryt EP, Twining P, Mulholland RC, Worthington BS. The prevalence of disc degeneration associated with neural arch defects of the lumbar spine assessed by magnetic resonance imaging. Spine. Sep 1989;14(9):977-81. [Medline].

  79. Schlegel JD, Smith JA, Schleusener RL. Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. Spine. Apr 15 1996;21(8):970-81. [Medline].

  80. Anderson SJ. Assessment and management of the pediatric and adolescent patient with low back pain. Phys Med Rehabil Clin N Am. 1991;2:157-85.

  81. Blackburne JS, Velikas EP. Spondylolisthesis in children and adolescents. J Bone Joint Surg Br. Nov 1977;59-B(4):490-4. [Medline]. [Full Text].

  82. Cyron BM, Hutton WC. Variations in the amount and distribution of cortical bone across the partes interarticulares of L5. A predisposing factor in spondylolysis?. Spine. Mar-Apr 1979;4(2):163-7. [Medline].

  83. Dunn AJ, Campbell RS, Mayor PE, Rees D. Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis. Skeletal Radiol. May 2008;37(5):443-50. [Medline].

  84. Elliott S, Hutson MA, Wastie ML. Bone scintigraphy in the assessment of spondylolysis in patients attending a sports injury clinic. Clin Radiol. May 1988;39(3):269-72. [Medline].

  85. Hambly MF, Wiltse LL, Peek RD. Spondylolisthesis. In: Williams L, Lin P, eds. The Spine in Sports. St. Louis, Mo: Mosby; 1996:157-63.

  86. Ivanov AA, Faizan A, Ebraheim NA, Yeasting R, Goel VK. The effect of removing the lateral part of the pars interarticularis on stress distribution at the neural arch in lumbar foraminal microdecompression at L3-L4 and L4-L5: anatomic and finite element investigations. Spine. Oct 15 2007;32(22):2462-6. [Medline].

  87. Kurd MF, Patel D, Norton R, Picetti G, Friel B, Vaccaro AR. Nonoperative treatment of symptomatic spondylolysis. J Spinal Disord Tech. Dec 2007;20(8):560-4. [Medline].

  88. Libson E, Bloom RA, Dinari G. Symptomatic and asymptomatic spondylolysis and spondylolisthesis in young adults. Int Orthop. 1982;6(4):259-61. [Medline].

  89. Muschik M, Hahnel H, Robinson PN, Perka C, Muschik C. Competitive sports and the progression of spondylolisthesis. J Pediatr Orthop. May-Jun 1996;16(3):364-9. [Medline].

  90. Raby N, Mathews S. Symptomatic spondylolysis: correlation of CT and SPECT with clinical outcome. Clin Radiol. Aug 1993;48(2):97-9. [Medline].

  91. Rossi F. Spondylolysis, spondylolisthesis and sports. J Sports Med Phys Fitness. Dec 1978;18(4):317-40. [Medline].

  92. Sairyo K, Sakai T, Yasui N. Conservative treatment of lumbar spondylolysis in childhood and adolescence: the radiological signs which predict healing. J Bone Joint Surg Br. Feb 2009;91(2):206-9. [Medline].

  93. Soler T, Calderon C. The prevalence of spondylolysis in the Spanish elite athlete. Am J Sports Med. Jan-Feb 2000;28(1):57-62. [Medline].

  94. Stewart TD. The age incidence of neural-arch defects in Alaskan natives, considered from the standpoint of etiology. J Bone Joint Surg Am. Oct 1953;35-A(4):937-50. [Medline]. [Full Text].

 
Previous
Next
 
Table 1. Outline of the Treatment Strategy Based on Results of Plain Radiographs and SPECT Scanning in the Evaluation of Defects of the Pars Interarticularis in Patients Clinically Suspected of Having Symptomatic Pars Interarticularis Lesions
Plain RadiographSPECT ScanInterpretationManagement
NegativeNegativePathology other than pars defect should be suspectedFurther investigation of cause of back pain should be performed (eg, MRI)
NegativePositiveEarly pars interarticularis fractureConservative management in form of rest, +/– bracing
PositiveHealingSpondylolysisConservative management in the form of rest and bracing
PositiveNegativePseudoarthrosis or old unhealed fractureConsider surgical intervention for stabilization to prevent spondylolisthesis and to relieve pain. Consider further investigation to rule out alternative pathology.
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.