Lumbar Spine Health Amongst Adolescents

Lumbar Spine Health Amongst Adolescents

Carlie Russell
KIN 275, 12-12:50 MWF

Lumbar Spine Health Amongst Adolescents

Introduction:
Young athletes, almost all of the time, become affected by some traumatic injury
that hinders, if not ends their athletic career. Spinal injuries and chronic back pain have
proven to be one of the most common disabilities amongst people. The pars
interarticularis (also referred to as the pars) is a part of the spinal vertebrae in the
vertebral arch. This anatomical landmark is located in between the superior and interior
facets on a typical lumbar spine vertebra. Spondylosis is considered a defect or fracture,
capable of being unilateral or bilateral, of the pars interarticularis (Middleton, 2009).
Similar to this defect, is lumbar zygapophyseal joint osteoarthritis (ZJO), or facet joint
osteoarthritis (Suri, 2015). ZJO, which like spondylosis, is also considered a degenerative
spinal injury (Suri, 2015). Although spondylosis is a word rarely known, its one of the
most common causes of lower back pain in children and adolescents (El Rassi, 2013). It
is often found among young athletes that take part in activities that require repetitive
flexion-extension of the spine. For example, many gymnasts, football players and
weightlifters become affected (Chamoli, 2014). Spondylosis is prevalent in
approximately 6-7% of the adult population. It is also estimated that the incidence for
children that are six years of age is around 5% (Snyder, 2014). Most cases of spondylosis
occur through nature, are predisposed and are believed to stem series of micro-traumas
(Chamoli, 2014). Treatments for this defect range from observation to surgery depending
on the severity of the fracture (Snyder, 2014). New treatments as well as improvements to
old ones are being considered daily. This spinal fracture affects adolescent athletes, and
hinders their ability to part take in general physical activity.

Lumbar Spine Health Amongst Adolescents

Effect of Physical Activity on Lumbar Spine Health:

Physical activity is very different from ones average everyday movements. For a
movement to be considered physical activity, it needs to be a voluntary action that is
executed to accomplish something specific. Exercise is also not the same as physical
activity. For something to be considered exercise, it has to be a planned, structured and
repetitive movement that is used to preserve ones physical fitness and or advance it.
Spondylosis and ZJO are typically brought about by repetitive actions completed while
exercising. For example, while one is executing a high bar squat, holding good form
tends to add a lot of pressure to the lumbar spine. This causes the vertebrae to compact
together as one continues their set. The repetitions in each set completed, are where the
repetitive micro traumas come into play. If someones form is even slightly off, it could
aggravate and cause these underlying defects to develop faster than they already were.
This condition is also relevant to young dancers and gymnasts. Both gymnastics
and dance are considered exercise and can cause very similar irritation. They require
flexion and release of the lower back; again causing the lumbar vertebrae to condense
together and when performed incorrectly, can cause these micro traumas. Dancers and
gymnasts often have one or more routines that are performed repeatedly. Although these
routines are a combination of various movements, they can also relate to weightlifters.
Every time a dancer practices their routine is similar to one set of a specific exercise for a
weightlifter. Movements if executed incorrectly cause these lumbar spine injuries and
force them to advance faster than they already had been.
Many people begin to experience chronic back pain from not only exercise but
also physical activity. People that perform tasks that require expending energy over an

Lumbar Spine Health Amongst Adolescents

extended period of time can also fall victim these stresses of the lumbar spine. Those who
are less active, are older and have less muscle mass are susceptible to these injuries as
well. Athletes and people that regularly participate in exercise are susceptible for different
reasons. Individuals with ZJO have been tested to see how the effect of weight, height,
sex and age along with how many hours of heavy physical activity make one more likely
to acquire this chronic back problem (Suri, 2015). The results show that as people of
older age, shorter stature, and a higher body weight are more disposed to develop ZJO.
That also goes for those who participate in three or more hours of heavy physical activity
(Suri, 2015). ZJO is a chronic back problem that is found more often in adults than
adolescents. It is also more commonly associated with regular physical activity as
opposed to athletic training and exercise.
These results are a perfect example of how spondylosis is different from ZJO.
Spondylosis is a defect that during adolescence and childhood develops into a fracture.
Spondylosis is not only a fracture of the pars interarticularis, but is a stress fracture.
Typically, breaks, sprains and fractures are a result of the impact of one specific action.
Stress fractures occur from repetitive stress, or micro trauma, to one specific entity. In
this case, spondylosis stems from consistent impact to the pars interarticularis, eventually
causing the vertebrae to break. After this break occurs, it creates space in between the
specific vertebrae, and when left without treatment, can lead to spondylolisthesis
(Chamoli, 2014).
Spondylolisthesis is less common in children and adolescents, but tends to be the
outcome when spondylosis is left untreated. Spondylolisthesis occurs when bilateral
spondylosis is left to deteriorate. As time goes by, the affected vertebrae will get pushed

Lumbar Spine Health Amongst Adolescents

forward causing it to be displaced. Spondylolisthesis is specifically known as the forward

displacement, due to the fractures of the pars interarticularis (Chamoli, 2014).
Spondylolisthesis is treated often times with invasive surgeries. A recent study on the
treatment of spondylosis was conducted. Doctors hypothesized that direct placement of a
screw through the pars would be less invasive than the more common pedicle screw-hook
construct. The study was small and only conducted on 16 patients (Snyder, 2014). The
doctors found medical records of these 16 patients all undergoing the same screw
placement surgery (Snyder, 2014). The medical records concluded that the surgery is not
only less invasive, but it also had satisfactory outcomes for all of the patients. All eight of
the subjects that were adolescent athletes were back participating in regular activity by
their last follow-up (Snyder, 2014).
Many doctors have taken other non-invasive approaches to treating spondylosis in
adolescents. Another group of doctors decided to do a study on how cessation of exercise
would affect adolescent athletes with symptomatic spondylosis (El Rassi, 2013). The
study was conducted on one hundred thirty-two athletes, 78 males and 54 females, with a
mean age of 13 years old (El Rassi, 2013). The patients that stopped all sports activities
for at least three months ended up having excellent outcomes. Patients that began their
sports activities before the three months were up had worse outcomes (El Rassi, 2013).
The subjects that ceased all sports activity for at least three months were 16.39 times
more likely to heal with excellent results, when compared to subjects that continued as
they had been. Doctors were able to come to the conclusion that it is extremely effective
for a timely cessation of all sports activity for at least three months, while treating
spondylosis (El Rassi, 2013).

Lumbar Spine Health Amongst Adolescents

Conclusion:
Spondylosis may seem like an uncommon defect, but has become one of the most
common, medically treated spinal injuries. Because it is a defect, theres really no telling
how it can be prevented. However, many treatments have been tested and have had
successful outcomes. Spondylosis can be treated and maintained by cessation of all sports
activities and exercise, and possibly invasive surgery. When caught early enough, there
are extremely simple treatment options, making this defect less severe and healable.
When the bilateral fracture is left for too long, the spinal health of the subject will begin
to deteriorate. This can lead to spondylolisthesis, which is the forward displacement of
the vertebrae (Chamoli, 2014). Also discussed is the facet joint osteoarthritis, commonly
referred to as ZJO. Although ZJO is a type of chronic back pain mostly found in older
adults, it helps contrast the difference between the pars interarticularis and the superior
and inferior facets. Though healable, many adolescents are forced to stop participating in
sports activities when spondylosis is left untreated. Research has proven that not only is
spondylosis common, but there are many easy treatments that allow affected adolescents
to return to their regular daily routine soon after the trauma.

Lumbar Spine Health Amongst Adolescents

References:
Chamoli, U., Chen, A.S., Diwan, A.D., (2014). Interpedicular Kinematics in an In Vitro
Biomechanical Assessment of a Bilateral Lumbar Spondylolytic Defect. Clinical
Biomechanics. 29 (10), pp.1108-1115
El Rassi, G., Takemitsu, M., Glutting, J., Shah, S.A., (2013). Effect of Sports
Modification on Clinical Outcome in Children and Adolescent Athletes with
Symptomatic Lumbar Spondylolysis. American Journal of Physical Medicine &
Rehabilitation. 92 (12), pp.1070-1074
Middleton, K., & Fish, D. E. (2009). Lumbar spondylosis: clinical presentation and
treatment approaches. Current Reviews in Musculoskeletal Medicine, 2(2), 94
104.
Snyder, L.A., Shufflebarger, H., O'Brien, M.F., Thind, H., Theodore, N., Kakarla, U.K.,
(2014). Spondylolysis Outcomes in Adolescents After Direct Screw Repair of the
Pars Interarticularis. J Neurosurg: Spine. 21 (), pp.329-333
Suri, P., Hunter, D.J., Boyko, E.J., Rainville, J., Guerazi, A. Katz, J.N., (2015). Physical
Activity and Associations with Computed Tomography- Detected Lumbar
Zygapophyseal Joint Osteoarthritis. The Spine Journal. 15 (1), pp.42-49