What is it?
The medical term for a “scotty dog” fracture is a spondylolysis (-lysis for short). This fracture is prevalent in the lower back region of the spine. It is a stable fracture, meaning it has no risk of compromising the spinal canal. The incidence of occurrence is roughly 5-10% of the population. It is frequently seen in sporting activities that demand repetitive back bending activities (i.e. gymnastics).
What symptoms are associated with it?
Commonly, it is lower back pain that is worsened with bending backward or to one side. The person will typically also suffer with muscle spasming and guarding of the lower back muscles. The person may have an ache that radiates to the knee, but it is unlikely to radiate below the knee.
What are the causes?
There is much debate in the spine community regarding the cause of spondylolysis. In some instances, a traumatic event will cause the spondylolysis. But many times, a person insidiously (without cause) develops back pain that an x-ray demonstrates evidence of the fracture. In those instances, it is not clear if the injury is congenital (birth defect) or acquired from a traumatic event.
How can you differentiate between an acquired or congenital spondylolysis?
It doesn’t matter. To properly treat the condition, we really need to determine if it is “active” or “inactive”. An “active” –lysis is one that is in the process of attempting to heal. Therefore, it has potential to heal with bracing and rest. If the –lysis is “inactive”, it will not heal.
How is it diagnosed?
Standard x-ray can determine a –lysis. Notice the fracture in the “collar” area of the Scotty dog. Once a –lysis is discovered on x-ray, a follow-up MRI or bone scan (nuclear medicine) can be utilized to determine if the fracture is “active” or “inactive”.
How do you treat a spondylolysis?
An “active” -lysis will require immobilization (a custom-fitted, rigid back brace) and rest for a period of 6-12 months. Rehabilitation focused to improve core stabilization and movement patterns will help the patient return to full activity without re-aggravation.
An “inactive” –lysis is treated symptomatically. Rehabilitation focuses on reducing muscle spasm/pain and improving core stabilization while avoiding back bending and symptomatic side bending. This patient will likely need to modify future activities to avoid re-aggravations.
Dr. Custer is the owner/operator of Better Care Chiropractic & Physical Therapy. He is a doctor of chiropractic as well as a retired Athletic Trainer. He combines chiropractic manipulation with active rehabilitative techniques to restore pain-free living. If you have questions/comments/suggestions, please feel free to contact Dr.Custer at [email protected]