Spondylolysis Treatment Options: Healing the Spine with an Injection Rather than Surgery Chris Centeno, MD / August 6, 2016 By

What happens when a precise stem cell injection is used instead of surgery to treat spondylolysis? This is the story of NH, an Ivy League wrestler whose career was stopped in its tracks by a traumatic fracture of the spine called spondylolysis. His parents knew that fusing this young man’s spine at his young age was a bad idea, so they began to research spondylolysis treatment options and eventually made their way to our Colorado clinic. Thankfully, at about two months following his stem cell procedure, NH appears to be on his way toward healing this fracture by harnessing the power of his own body rather than using plates and screws.

What Is Spondylolysis?

Spondylolysis is the Latin term for, literally, “cracked spine.” Some kids are born with weak areas in their spine with the most common place being the pars interaticularis. Understanding a little more medical Latin (arrrghhh), this literally means the “part between the joints.” This is the piece of bone that lives between the low-back facet joints. It’s also called the “pars” by many doctors. For some kids, the area is never connected by bone, and for others, it’s a bony weak spot waiting to break. These injuries are common in gymnasts, wrestlers, and other athletes who place tremendous stress on their spines. It’s even common to see among athletes who play sports that feature less contact, like tennis, volleyball, baseball, and diving. When they occur, they cause back pain that’s usually worse with bending back. When physical therapy fails, many of these kids end up with fusion surgeries or other procedures that use plates or screws to hold the area together. Obviously, any back surgery will destroy important stabilizer muscles, so many of these kids who end up with surgery have complications at a later date.

Spondylolysis is surprisingly common. In fact, anywhere from 4% to 6% of people have it. Many of them don’t even know they have this condition. One of the most common symptoms is pain in the lower back, but due to the frequency of people experiencing lower back pain, they often don’t know if it’s from spondylolysis or some other issue. Pain from spondylolysis tends to spread from the lower back to other adjacent areas such as the buttocks or even the legs. The more strenuous activity a person does, the more severe the pain will feel.

One of the keys to identifying spondylolysis is timing. Most of the time, the symptoms will start to occur during the teenage years as young people experience a growth spurt. Diagnosing spondylolysis usually requires an imaging technique such as an MRI, X-ray, CT scan, or bone scintigraphy, which is a type of bone scan.

Some patients may try to ignore the pain or simply “play through it,” but that can lead to further problems. Untreated spondylolysis can lead to spondylolisthesis. This is where the vertebra is weakened to the point where it becomes displaced in the spine. Doctors can diagnose this condition as high grade or low grade depending on how displaced it is. The more displaced the vertebra is, the more pain the patient will experience.

Anyone who has experienced back pain knows how awful it can be. It limits your movement and can cause even the most routine activities to feel agonizing. That’s why so many patients are willing to go to drastic measures like spinal fusion to treat the problem. Major back surgery is not something that should be looked at lightly, though. The possibility of experiencing future problems with that type of treatment is too great. So what if there were a better way to deal with spondylolysis that was still effective but without the negative long-term consequences?

What if We Could Eliminate the Surgery and Prompt Healing with Just a Precise Injection?

Surgery for spondylolysis is a big problem. Many of these kids will be able to heal the problem with just bracing or PT, but for those who want to return to competition and can’t heal the fracture—surgical fusion is often recommended. Fusion is where the level is bolted together, limiting movement and destroying important low-back stabilizing muscles. While these procedures get them back to play, many of these kids go on to have other problems caused by the low-back fusion, including adjacent segment disease (where the normal levels above and below can develop problems due to overload). In addition, we all take for granted that the small muscles close to our spine (multifidus) constantly stabilize our vertebrae. Surgical fusion can destroy these muscles, leading to a weaker spine that can’t protect itself during sports.

Way back in 2006, we began to use the patient’s own stem cells to help heal nonhealing fractures. Rather than surgically implanting them like a bull in the proverbial china shop of the body, we used precise image-guided injections. The results were good, so we published a research paper on the topic. More recently, we’ve been using that same basic technology to begin to heal spondylolysis fractures in young adults who would otherwise be facing a massive fusion surgery. This is the story of one such patient.

NH’s Low-Back Spondylolysis Story

NH is a 19-year-old collegiate wrestler who injured his low back in the sport he loves. His doctors did a very good spine work-up, which showed a spondylolysis. The right side of his back had what appeared to be a recent fracture that wouldn’t heal, and the left side had a gap in the bone that looked like it had been there since birth. So he had one type of spondylolysis on the right (a weak bone that fractured due to stress) and the other type on the left (the missing gap in the bone since birth that was never connected). The right side with the recent fracture hurt and the left side didn’t. With a diagnostic numbing injection, his doctors confirmed that the right side was the pain generator. Being enlightened physicians who recognized that fusing a 19-year-old kid is a really bad idea, they tried a same-day stem cell injection into the right side under guidance, but it failed to heal. Knowing that we have a decade of experience with using stem cell injections to heal fractures, they sent NH to our Colorado clinic for more-advanced spondylolysis treatment options.

Interventional Orthopedic Spondylolysis Treatment Options

Given that the right side was an acute fracture, I felt that if we used a different technique, we could likely get it to heal. I also felt that since his body had never built bone on the left, it was unlikely to heal. In early June, I used a small specialized bone needle to cause small microinjury to both sites and used a specialized Regenexx same-day bone-healing procedure that uses a biologic scaffold. No surgery was performed, and the patient was braced for seven weeks, until the postinjection CT scan above was performed. The image on the left (yellow-dashed circle) shows a right-sided pars fracture that wasn’t healing (you can see a clear fracture line that snakes through the enlarged bone). Since this is a CT, the right and left are reversed (the left side of the image shows the right and vice versa). On the seven-week-postinjection film, the fracture line is healing nicely (yellow-dashed circle on the right). This is still an early image, so we’ll likely see much more healing over the next few months. His right-sided low-back pain that has been a constant feature for many months is now gone as well. He’s been cleared to begin rehab and will take a medical red shirt this season while he gets stronger and works in more wrestling stresses on his back.

The upshot? It’s great to see that we can help kids like NH avoid the fusion bullet with autologous spondylolysis treatment options. Fusing the spine of a young adult is like using a sledgehammer to put in a thumbtack, with all of the collateral damage that entails. Hopefully NH will finish out his career not with bolts and screws in his back but with many pins to the mat!