Spondylolysis diagnosis begins with a complete history and physical exam. The doctor will ask questions about the worker’s symptoms and how the problem is affecting his or her daily activities. It is important that the worker explains how his job duties affect his or her symptoms, if they do. Doctors may suspect if certain activities impact spondylolysis symptoms. The doctor will also want to know what physical positions or activities make the symptoms worse or better.
Next the doctor examines the worker by checking your posture and the amount of movement in your low back. The doctor checks to see which back movements cause pain or other symptoms. Skin sensation, muscle strength, and reflexes are also tested.
The doctor may order an X-ray of the low back. An angled, or oblique, view is often used to check for a pars fracture. The doctor traces around the vertebral body and bony ring on the X-ray film. The outline normally forms an image that looks like a small dog. When a crack is present, however, the dog will appear to have a collar around its neck. This is referred to as the Scotty dog sign. It confirms a diagnosis of spondylolysis.
Small defects in the bone may not show up on X-ray. Also, a recent stress fracture won’t always appear on X-ray. As a result, the doctor may order a bone scan to get the most accurate information. This involves injecting chemical “tracers” into the blood stream. The tracers collect in areas of extra stress to bone tissue, such as a stress fracture of the pars interarticularis.
Computed tomography may be ordered. A CT scan that lets doctors see slices of the body’s tissue. The image can show if the edges of the fractured bone have begun growing together. The scan shows whether the fracture is new or old, so doctors can decide which treatments will help the most.
When more information is needed, the doctor may order a magnetic resonance imaging (MRI) scan. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. It can help in the diagnosis of spondylolysis. It can also provide information about the health of nearby intervertebral discs and other soft tissues that don’t appear on X-rays.
McCormick Law Office in Milwaukee, Wisconsin is not intimidated by IME doctor reports that invariably discount any work-related or job duties connection to spondylolysis. Yes, there are congenital and other factors, but we take the worker as we find him or her, and if the job contributes to the disability caused by spondylolysis, then its work-related in our book and we will fight to prove the case.
