Spondylolysis (spon-dee-low-lye-sis) is defined as a defect or stress fracture in the pars (部分)interarticularis(峡部)(关节间部) of the vertebral (脊椎的)arch(弓形).The vast majority of cases occur in the lower lumbar(腰椎) vertebrae (L5), but spondylolysis may also occur in the cervical (颈部) vertebrae.
- Status – patient age
we could not find more documents cases in China, maybe more patients shame to share this on internet. You can imagine that if someone complain his/her spondylolysis and try to explain the meaning of break in lumbar vertebrate, the audience would laugh with a strange face. Because they will connect the lumbar to waist , to kedney and all of these will tell the situation that his/her sexy life sure to be impacted.
That’s the situation, that’s why most of patients age will be 40, or more.
- status – our dear doctors
I’ve consulted several doctors and all of them tell me , surgery of course, and ONLY lie on 3-4 month and then you come alive back. Any other non-surgery approach ? NO ! They will ask you to have a decision quickly and then they can arrange the surgery bed , because in China, the hospital beds is very hard to get and you need to queue up several months or years.
I want to postpone the surgery and want to find a way to do some physical training. But could not.
Treatment for spondylolysis and spondylolisthesis is not much different than for other causes of mechanical and/or compressive back pain. In most cases, surgery will not be necessary. Strengthening the back muscles can reduce the mechanical symptoms resulting from the segmental instability.
A physical therapist will probably be recommended to help you with a series of exercises designed to help stabilize the spine by strengthening the back and abdominal muscles.
Medications may be used for short periods to: control pain, ease muscle spasms, and help regain a normal sleep pattern (if you are having trouble sleeping). Short periods of bed rest may help with acute painful episodes.
A back brace, or corset, may reduce pain.
Conservative management 保守治疗
Treatment for spondylolysis ranges from bracing, activity restriction, extension exercises, flexion exercises and deep abdominal strengthening, that is administered through physical therapy. The duration of physical therapy a patient receives varies upon the severity of spondylolysis, however typically ranges from three to six months. The goal of physical therapy is to minimize movement at the unstable defect of the pars interarticularis. Once a patient completes physical therapy, and displays no symptoms or inflammation in the lower back, they are cleared to continue with daily or athletic activities. However, a patient may need to maintain a variety of rehabilitation techniques after physical therapy to prevent the recurrence of spondylolysis.
Deep abdominal co-contraction exercises 腹部练习
The aim of deep abdominal co-contraction exercises is to train muscles surrounding the lumbar spine which provide stability of the spine. Spondylolysis results in a spinal instability and disrupts patterns of co-recruitment between muscle synergies. Specifically, local muscles that attach directly to the spine are affected. The lumbar multifidis and transversus abdominis play a direct role in stabilizing the lumbar spine. Instead the local muscles in individuals with spondylolysis are vulnerable to dysfunction, which results in abnormal spinal stability causing chronic low back pain. To compensate, the large torque producing global muscles are used to stabilize the spine.
In one study, patients are taught to train the co-contraction of deep abdominal muscles and lumbar multifidus in static postures, functional tasks and aerobic activities. This technique was shown to reduce pain and functional disability when compared to other conservative treatments. These results also had a long- term effect in reducing levels of pain and functional disability. This is because motor programming eventually became automatic, and conscious control was no longer needed to contract the deep abdominal muscles during activities.
laminectomy – 椎板减压、切除术
anatomy – 解剖
interbody fusion – 椎体间融合术