Low back pain in adolescent athletes is most commonly attributed to a stress fracture in one of the bones (vertebrae) that make up the spinal column. The technical term for this condition is spondylolysis. This condition usually affects the fifth lumbar vertebra in the lower back and in some cases the fourth lumbar vertebra.
In cases where the stress fracture deteriorates the bone so much that normal position is not maintained, the vertebra may begin to shift out of place, resulting in spondylolisthesis. Should too much slippage occur, the bones may begin to press on nerves and corrective surgical options may become necessary.
It is possible that spondylolysis may be related to heredity. Individuals born with thin vertebral bone may be predisposed to this condition. Additionally, considerable periods of rapid growth may further slippage.
Gymnastics, weight lifting, football and other sports that place a great deal of stress on the bones in the lower back may result in spondylolysis or spondylolisthesis. These sports also require that the athlete constantly overstretch (hyperextend) the spine. In both cases, a stress fracture on one or both sides of the vertebra is the result.
Oftentimes, spondylolysis and spondylolisthesis are present without any obvious symptoms. Pain may radiate across the lower back and feel like a muscle strain.
Possible symptoms of spondylolisthesis may include spasms that stiffen the back and tighten the hamstring muscles. This results in changes to posture and gait. With significant slippage, the nerves may compress and the spinal canal may narrow.
Evaluation of back and neck pain requires a physician experienced in diagnosing spinal conditions. The work-up begins with a detailed history and physical examination. Your medical history helps your doctor understand your back and neck pain, and the influence of your lifestyle in contributing to your pain.
During your physical exam, your neurosurgeon examines your spine and neurological system to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted. Diagnostic tests may be ordered to confirm the location and source of your pain.
The first step is usually a set of X-rays. X-rays show the bones (vertebrae) of the spine.
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI) uses a magnetic field and radio waves to generate highly-detailed pictures of the inside of your body. The MRI depicts soft tissues of the muscle and discs as well as nerves. These images help your neurosurgeon provide a more accurate diagnosis. This type of imaging is very safe and usually pain free. In most cases, injections are not required. However, in some situations, a contrast agent may be needed to enhance the ability of the MRI to see into your body.
Myelogram Followed by CT
A myelogram determines any decreases or blockages in the flow of cerebral spinal fluid (CSF) around your spinal column. It is used to diagnose a bulging disc, tumor or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into your lower back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected and a series of X-rays taken. Once the myelogram is completed, you are sent for a CT scan.
Intrathecal CT determines blockages or flow of cerebral spinal fluid around the spinal column. A local anesthetic is injected into the lower back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected. This procedure is followed by a CT scan, which takes a series of detailed pictures of the spinal area.
Electrical testing of the nerves and spinal cord may be performed before, during and after surgery. These tests, called Electromyography (EMG) or Somato Sensory Evoked Potentials (SSEP), assist your neurosurgeon in understanding how your nerves or spinal cord are affected by your condition.
Bone Scan with SPECT
Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also accurate for finding lesions for biopsy or excision. The uses of single-photon emission tomography (SPECT) techniques contribute significantly to the diagnostic accuracy of the scan.
A small amount of radioactive material (tracer) is used to visualize all the bones in your body. Approximately three hours after the tracer has been injected into a vein, a scan takes place.
Discography is a procedure used to determine the internal structure of your disc. It is performed by using a local anesthetic and injecting a dye into your disc under X-ray guidance. An X-ray and CT scan are performed to view the appearance of the disc composition to determine if its structure is normal or abnormal. In addition to your disc appearance, your doctor will note if you have pain with this injection.
Conservative treatments should always be considered first when treating spondylolysis. Resting and refraining from usual activities, taking anti-inflammatory medication, and incorporating a stretching and strengthening program are all common nonsurgical treatment methods. With time, as ligaments and muscles hold the vertebrae in place, surgery may be necessary to install surgical instrumentation or bone grafts that lock the vertebra in place so that it does not slide out of position and damage the spinal nerves. Possible surgical options may involve fusion and/or screws and rods.