Nonsurgical Treatment for Spondylolysis
Regardless of age, most people with spondylolysis, a spine condition in which a stress fracture develops on a vertebra, find that nonsurgical treatments, such as physical therapy and bracing, relieve pain and improve function.
Physicians at NYU Langone’s Spine Center work closely with rehabilitation experts at Rusk Rehabilitation to help you return to an active lifestyle as quickly as possible.
During treatment, your doctor may take periodic X-rays of your spine to monitor the affected vertebrae and ensure that the condition doesn’t progress to spondylolisthesis. This occurs when a stress fracture turns into a complete break, causing the vertebra to slip forward and out of place.
Children and teenagers who are treated for spondylolysis should be examined annually until they are 16—even if treatment relieves symptoms. Spinal bones continue to grow until puberty, and symptoms of a stress fracture may reappear during a teenage growth spurt. Growth spurts increase the risk that a stress fracture may progress to spondylolisthesis. Once a person stops growing, the risk of progression decreases significantly.
In adults, degenerative conditions such as osteoarthritis of the spine and degenerative disc disease may increase the risk that an existing stress fracture worsens. Nonsurgical treatment, as recommended by your doctor, can help reduce the risk.
Activity Modification and Bracing
If certain sports or activities increase lower back pain, your doctor may recommend taking a break from them until the pain subsides. This doesn’t mean you should stay in bed. Participating in activities that don’t aggravate your back can increase blood flow to the spine and speed your recovery.
Your doctor may also recommend wearing a back brace to support your lower back and prevent the spine from developing unusual curves. Orthotics specialists at NYU Langone can create a custom-fit brace for you, ensuring that it is comfortable to wear. Generally, doctors recommend wearing the brace any time you are not resting for two to four weeks. Your doctor determines the right type of brace for you and how long you should wear it.
Physical therapy can relieve lower back pain and help you gradually return to sports and other activities. At Rusk Rehabilitation, physiatrists—doctors who specialize in rehabilitation medicine—and physical therapists can show you simple exercises to strengthen the muscles in your abdomen and back. Strong abdominal, or core, muscles reduce the amount of stress absorbed by the spine, creating an internal “brace” that supports and stabilizes the spine.
Stretching muscles and tendons that support the spine can also relieve discomfort and remove stress from the lower back. People with spondylolysis often have tight hamstrings, muscles that run along the backs of the legs between the buttocks and knees. Physical therapists can teach you stretching exercises that you can perform daily at home.
Our physical therapists create a customized exercise routine for you based on your symptoms and the results of diagnostic imaging tests, such as X-rays, to ensure that treatment is geared toward your specific injury.
Your doctor may recommend 6 to 12 weeks of physical therapy either at NYU Langone or a facility near your home. Your physical therapist evaluates your progress every six weeks to determine whether further treatment is needed.
Pain Relief Medication
Your doctor may recommend an over-the-counter nonsteroidal anti-inflammatory drug, or NSAID, to relieve lower back pain and help you remain active. Inflammation in the spine and the surrounding soft tissues can cause irritation and swelling that worsens during movement. NSAIDs reduce inflammation and alleviate pain.
The most common NSAIDs are ibuprofen, naproxen, and aspirin. All are available without a prescription, and your doctor can advise how much to take and how frequently. If spondylolysis causes serious pain that is not relieved by over-the-counter medications, your doctor may prescribe a more potent anti-inflammatory.
A corticosteroid injection delivers anti-inflammatory medication directly to the spine and may provide long-term pain relief. Most of the time, an injection is recommended only after other nonsurgical treatments have failed to alleviate pain. Corticosteroids can be injected into the fractured bone or into the epidural space, the area surrounding the outer sac of the spinal cord and nerve roots, which holds the nerves and spinal fluid.
Epidural injections are usually recommended only if there is a narrowing of the spinal canal, called spinal stenosis, as well as spondylolysis.
These injections are performed using local anesthesia, and NYU Langone pain management specialists and radiologists use X-ray guidance to ensure the medication is injected into the right place. The procedure typically takes less than 30 minutes.
Pain relief from injected steroids may last from a week to a year or even longer. They are most effective when used just before beginning physical therapy, allowing a person to do strength-building exercises for the abdomen and back without pain. However, the injections do not work for everyone.