History

Among the general population, most cases of lumbosacral spondylolysis (lumbar spondylolysis) are clinically inapparent, and the condition is symptomatic in only 10% of patients.^[16]Many athletes with lumbosacral spondylolysis (lumbar spondylolysis) are likewise asymptomatic.^[10]

Lumbosacral spondylolysis (lumbar spondylolysis) typically occurs in young people,^[1]with a mean age at diagnosis in athletes of about 15-16 years.^[10]

Patients with lumbosacral spondylolysis (lumbar spondylolysis) generally report low back pain aggravated by activity,^[30]particularly with hyperextension maneuvers such as in gymnastics. In general, patients present without a history of neurologic symptoms.^[12]

Physical Examination

The physical examination of the patient with lumbosacral spondylolysis (lumbar spondylolysis) frequently yields the following minimal findings:

No tenderness to palpation is noted, but some discomfort can be elicited with deep percussion over the midline of the lumbar area.
Range of motion is full.
Because of the previously increased range of motion of dancers and gymnasts, they appear to have normal flexibility. Athletes suspected of having an injury must have their flexibility compared with that of their preinjury state.
Forward flexion does not increase symptoms.
Hyperextension mimicking the sporting movement generally elicits pain.^[12]
Sciatica can occur but is rare.^[31]
Physical findings that may also be present include antalgic or normal gait, tight lumbar musculature and hamstrings, hyperlordosis, and buttock or thigh pain.

If a unilateral defect is present, the 1-leg hyperextension test elicits pain on the involved side. This test is performed by the patient bearing weight on one leg, with both the hip and knee of the other extremity flexed while hyperextending the lumbar spine.^[12] The maneuver is performed on both sides, and asymmetric low back pain indicates unilateral disease. Bilateral disease may show symmetric or asymmetric pain with this maneuver.^[30]

The neurovascular examination findings are normal. The rest of the general low back pain examination must be performed, taking note of all dermatomes, myotomes, and reflexes.^[31]

Differential Diagnoses

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Media Gallery

Radiograph of L4 defect in the pars interarticularis.
Computed tomography scan demonstrating defects in the left and right pars interarticularis.
Long TR (T2-weighted) fat suppressed sagittal magnetic resonance image shows increased signal in the pars interarticularis on the left at L5 (same patient in Images 3-4). This is an acute stress reaction.
Sagittal short TR (T1-weighted) magnetic resonance image shows decreased signal in the pars interarticularis on the left at L5 (same patient in Images 3-4).
Lateral radiograph of the lumbar spine shows spondylolysis at L5 with spondylolisthesis at L5 through S1. On this single view, it is not possible to determine if these pars defects are unilateral or bilateral. Oblique views may help resolve this issue.
Sagittally reconstructed computed tomography scan of the lumbar spine shows a defect of the pars interarticularis on the left at L5.
Lumbar oblique radiograph showing the "Scotty dog." A pars defect is seen at L5.

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Lumbosacral Spondylolysis Clinical Presentation

History

Physical Examination

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