The neurologic exam will usually be normal and there will not be any root tension signs. The exam must include a vascular evaluation including an assessment of peripheral pulses. Plain radiographs will often demonstrate severe degenerative changes throughout the lumbar spine. Magnetic resonance imaging will confirm the diagnosis but a lumbar myelogram remains the gold standard for accurately revealing the severity and location of the pathology. Initial management can include anti-inflammatory medications, a light aerobic exercise program and analgesics.
Epidurals are also useful in managing the pain but the symptoms usually return.
Surgical decompression of the spinal canal gives predictable long-term relief. This typically involves removing the compressive structures such as osteophytes and part of the enlarged facet joints. Occasionally a fusion is required to prevent recurrence or instability. An isthmic spondylolysis is a developmental fatigue fracture of the pars, which typically occurs during childhood. A spondylolisthesis indicates a slippage of one vertebral body on another secondary to this lesion in the pars.