Injured Backs Wired for Athletics
Back pain from spondylolysis can keep an athlete out of the game or sport. Spondylolysis is a defect in the pars interarticularis (pars) in the spine.
The pars is an area in the protective bony ring on the back of the spinal column. There is one pars on the left, and one on the right of each vertebra. A bony defect in the pars can actually create a separation in the bone. If the condition happens on both sides of the bony ring, the vertebra can slip forward over the one below it. This slippage is called spondylolisthesis.
Treatment with bracing and rest works for most people with spondylolysis. If treated early, many of these fractures will heal. However, young athletes with chronic pain from spondylolysis may have to quit sports.
This study presents the results of a new surgical treatment for spondylolysis. Bits and pieces of shaved bone are placed at the fracture site. This is called a bone graft. A wire is then tied around the broken bone. Patients wear a hard back brace called a lumbar orthosis for three months after surgery. Jogging is allowed at six months, and by 12 months the athlete is back to full sports activity. All the patients had complete healing of the pars. They were able to return to sports, although not everyone went back to the previous level of activity.
Not all athletes with spondylolysis can have this operation. Patients must be under 40 years of age. The spondylolysis must not have created a slip of the vertebrae (spondylolisthesis) greater than 25 percent, and there can be no nerve root irritation. Finally, the site of bone wiring must be large enough to pass a wire through.
Segmental wiring of the spine can get an athlete back to sports sooner. The authors think that if there's a solid bone union, contact or collision sports can be allowed after this form of treatment in the patient with spondylolysis.
Satoshi Nozawa, MD, et al. Repair of Pars Interarticularis Defect by Segmental Wire Fixation in Young Athletes with Spondylolysis. In The American Journal of Sports Medicine. May/June 2003. Vol. 31. No. 3. Pp. 359-364.