What is a stress fracture of the spine?

A stress fracture in the spine involves a hairline crack in the bone that makes up the framework of the spinal cord. This condition most commonly occurs in the lower back or the lumbar region of the spine, generally due to excessive or repeated strain caused to it.

Spinal stress fracture is categorised into the following types, depending on the effect of the hairline crack on the vertebra:

  • Spondylitis – The upper and lower portion of the lumbar spine is joined by pars interarticularis. It is normal among many children, but if the pars fractures or cracks, it can lead to a condition known as spondylolysis. It usually affects the fifth lumbar vertebra on the lower back and less commonly the fourth lumbar vertebra.
  • Spondylolisthesis  In this condition, the fracture gap at the pars widens and the vertebra shifts forward. In most cases, it is the fifth lumbar vertebra that shifts on the sacrum (part of the pelvic bone). Lateral spine x-rays help determine the amount of slippage that has occurred. If the slippage is extensive, it might press on the nerves and might necessitate surgery to correct the condition.

What are the causes of the disorder?

Stress fractures are tiny hairline breaks that occur in the bone. These can result from high impact, back hyperextension or repeated stress to the spine. There are two main causes for stress fractures of the spine:

  • Overuse – Certain sports like weight lifting, football and gymnastics place a great amount of stress on the bones of the lower back, and also require overstretching of the spine. This can lead to stress fracture on one or both sides of the vertebra.
  • Genetics – Certain genetic factors like being born with a thin vertebral bone can make an individual susceptible to this condition. Further, substantial periods of rapid growth can also lead to bone slippage.

What one needs to know about symptoms or signs?

Many people may have spondylolysis and spondylolisthesis but may not show any direct symptoms. Pain, if it occurs, generally spreads across the lower back and is felt as a muscle strain. Nerve compression pain may also occur when the body attempts to heal the fracture. It is felt in form of sciatica or pain that radiates down the legs, accompanied with numbness or a ‘pins and needles’ sensation and weakness. The pain and accompanying symptoms can worsen over time or if the fracture becomes larger. The pain can also increase by standing, may disrupt sleep and is not relieved by sleep.

What are the screening tests and investigations done to confirm or rule out the disorder?

The doctor diagnoses stress fracture of the spine by reviewing a patient’s medical history and conducting a physical examination. The patient must disclose any information regarding physical training, sports activities or job duties that may contribute to a stress fracture in the lumbar spine.

Imaging tests like x-ray, computed tomography (CT) scans, single emission computed tomography (SPECT) scans, magnetic resonance imaging (MRI) scans, or bone scans create images of the vertebrae to show the site of fracture and vertebral alignment.

What treatment modalities are available for management of the disorder?

Majority of the cases are treated through non-surgical methods aimed at healing the fracture and managing pain. Physical activity is restricted at the start of the treatment and the doctor may recommend a back brace for few months to provide support to the spine. Anti-inflammatory and pain medication is given to ease discomfort. Physical therapy is part of the treatment plan and aims at stretching the hamstrings and strengthening back and abdominal muscles. Physical activity is gradually increased along with the treatment course.

What are the known complications in management of the disorder?

Non-surgical pain treatments cannot correct structural abnormalities in the spine. In case of spondylolisthesis, spinal fusion surgery is used to secure the bones together.

Is there any risk to other family members of having the disorder?

Some individuals are born with thin vertebral bones that make them susceptible to spondylolysis.

How can the disorder be prevented from happening or recurring?

According to the American Academy of Orthopaedic Surgeons, the following tips can prevent stress fractures:

  • Set incremental goals when participating in a new sporting activity.
  • Cross train (alternate activities that accomplish the same fitness goals).
  • Eat a healthy diet and include vitamin D and calcium-rich foods in the meals.
  • Use proper fitness equipment.

Suspend activity if pain or swelling occurs. In case of persistent pain, visit an orthopaedic surgeon.

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