椎弓峡部裂

Spondylolysis is a small stress fracture or crack in a part of a lower‑back vertebra, most often in teens and young adults who do repeated back‑bending activities (like gymnastics, football, or dance). It often causes low back pain but usually does not involve nerve damage, and most people improve without surgery.​

1) What is this condition?

  • It is a tiny break in a thin bridge of bone at the back of a vertebra (the “pars”), usually in the lowest lumbar bones.​

  • It can occur on one or both sides of the vertebra and is considered the middle stage in a spectrum from early stress reaction to slippage of one vertebra on another (spondylolisthesis).​

2) How serious is it?

  • Most cases are not dangerous and mainly cause activity‑related low back pain and stiffness.​

  • If not recognized and stress continues, the fracture may fail to heal and can allow the vertebra to slip forward, which can sometimes cause nerve irritation or more lasting back problems.​

3) Non‑surgical treatments

  • Rest and activity change: temporarily stopping sports and movements that extend or twist the low back (often for several weeks to a few months).​

  • Back bracing: a lumbar brace for 4–6 (sometimes up to 12) weeks to limit backward bending and allow healing.​

  • Medicines: anti‑inflammatory drugs and occasional short‑term pain medicines to control pain.​

  • Physical therapy:

    • Core and hip strengthening, hamstring and hip‑flexor stretching, posture training, and gradual return‑to‑sport programs.​

    • Addressing movement patterns and sport technique to reduce repeat stress.​

4) Types of surgery that may be necessary

  • Direct repair of the pars defect: placing screws or wires across the crack to hold it while it heals, typically in younger patients with isolated spondylolysis.​

  • Spinal fusion: joining one or more vertebrae together with bone graft and hardware (screws/rods) when there is significant vertebral slippage, instability, or nerve compression.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Allow the stress fracture to heal, relieve pain, and restore normal movement and sport participation.​

    • Prevent progression to vertebral slippage or chronic low back pain.​

  • Surgery goals:

    • Stabilize the broken segment when it remains painful and unstable despite good conservative care.​

    • Correct or stop slippage and relieve any nerve pressure, improving pain and function.​

6) How surgery can “fix” the problem

  • Direct pars repair holds the two sides of the crack tightly together so new bone can bridge the gap, preserving normal motion at that level.​

  • Fusion surgery uses screws and rods to hold the vertebrae still while bone graft placed between them heals into a solid block, eliminating painful motion.​

7) Risks of surgery (general and specific)

  • General risks: infection, bleeding, blood clots, anesthesia complications, and wound problems.​

  • Pars repair/fusion‑specific:

    • Nerve irritation or injury causing leg pain, numbness, or weakness (uncommon in experienced centers).​

    • Failure of the bone to fuse fully (nonunion) or hardware problems, which may require further surgery.​

    • Loss of some spinal motion at the fused level and extra stress on nearby levels over time.​

8) Chances this surgery will work

  • For low‑grade slippage treated with fusion, studies report fusion rates around 86–96% and high rates of pain and function improvement at 5–10+ years.​

  • Most series show 70–90% of patients satisfied with long‑term results after fusion for symptomatic spondylolysis/spondylolisthesis.​

  • Outcomes are best when surgery is reserved for patients with clear structural problems and persistent symptoms despite good non‑surgical care.​

9) Possible complications from the surgery

  • Wound infection, scar pain, or bleeding.​

  • Persistent or recurrent low back pain despite a successful fusion or repair.​

  • Adjacent‑segment wear (degeneration at levels above or below the fusion) years later.​

10) Typical recovery from the condition

  • With early diagnosis, rest, bracing, and therapy, more than 80% of patients treated non‑surgically have successful symptom resolution within about a year.​

  • Many young athletes can return to full sports once pain‑free, strength and flexibility are restored, and imaging is stable.​

  • If ignored, chronic pain and progression to slippage may occur, making treatment more complex.​

11) Typical recovery after surgery

  • Hospital stay is usually 1–3 days for most lumbar fusions or pars repairs.​

  • First weeks: limited bending, lifting, and twisting, with walking encouraged; pain and fatigue are common but gradually improve.​

  • Months: formal physical therapy, gradual return to activities; bone fusion often takes 6–12 months, and full return to high‑impact sports is usually delayed until solid healing and surgeon clearance.​

12) How long in the hospital

  • Most spondylolysis‑related surgeries (pars repair or single‑level fusion) are short‑stay, with discharge in 1–3 days if there are no complications.​

13) Long‑term outlook

  • Overall prognosis is very good; most people, especially children and young adults, do well with non‑surgical care and return to normal activities.​

  • When fusion is needed for persistent symptoms or slippage, long‑term studies show durable pain relief and function in the majority of patients.​

  • A small number may have ongoing back pain or additional spine wear over time, needing ongoing management.​

14) Need for outpatient follow‑up

  • Regular follow‑up with orthopedics/spine and physical therapy during healing to guide activity limits and progression back to sports.​

  • Periodic imaging (X‑rays, occasionally CT/MRI) to monitor healing of the pars and check for any slippage.​

  • After surgery, scheduled visits and imaging confirm fusion and hardware position, and long‑term reviews watch for adjacent‑level problems or recurrent pain.