This condition produces stress fractures in the pars interarticularis parts of vertebrae and arises as a result of a deformity or trauma. The L5 and S1 joints are mostly affected and attendant lesions are usually found in 5% of the population. The ligamentum fluvum (supporting ligaments of the vertebrae) become thicker and soft tissues are produced in a larger quantity affecting the local vascularity and nerve supply. All the biomechanics of the segment become affected and bone density can alter resulting in stiffness and less mobility of the affected joints. It is mainly a developmental condition which often produces Spondylolesthesis.Extensions and lateral flexion causes an increase in the sheer stresses on the pars interarticularis, but after the age of 20 the spine responds to the condition by forming its own means of stability. It is commonly seen in female gymnasts and for some reason football lines-men and soldiers who have regularly carried back-packs. Research has shown that patients who do not walk much are seldom affected.
Surgery is considered if mobility or gait is impaired, the purpose being to provide stability by fusion to keep the affected vertebrae solid. However, bone density decreases with old age and therefore relapses can occur requiring further operations. The visceral organs near the level of the spine affected can also seemingly be affected when displacement occurs, producing for example 'kidney pain' when the organs themselves are perfectly healthy.
It is essential to directly increase the mobility of the affected joints and indirectly the soft tissues without causing any direct rupture of the tissues themselves (which although thick are nevertheless for this condition useful for containing the condition). No manipulation should be conducted for this condition because further slippage or damage can be caused - and this applies particularly to chronic cases.
If there is any segmental instability due to repetitive trauma through movement then stress fractures may occur which can heal of themselves but it is important to help them heal in a proper alignment. This is achieved through a combination of treatment modalities such as mobilisation, ice packs, and isometric exercises.
Treatment as always must be preceded by an accurate diagnosis of the specific condition.
It can safely be said that for the vast majority of spinal conditions surgery is neither necessary nor effective, as it almost always leads to long term complications and suffering for the patient, out of all proportion to the original condition. The use of metal rods, screws and plates and the cutting away of parts of the spine, even the heating of discs to cause them to shrink (IDET procedure) represent a rather crude approach to the treatment of spinal problems and is not a method of 'treatment' that we can ever recommend.
The procedures of Orthopaedic Medicine outlined above do not involve operating on a patient, and all treatment is safe and manageable as well as being highly effective.