Spondylolysis & Spondylolisthesis

Spondylolysis

Spondylolysis is a condition that causes frequent low back pain in children because of a defect in the lumbar vertebrae.

It is more common among children and teenagers who participate actively in sports such as football, weightlifting and gymnastics. This defect can cause stress fractures or breaks in the vertebrae that weaken the bone and lead to slippage, a condition referred to as spondylolisthesis.

Symptoms

Although initially the patient may not have any symptoms, lower back pain may appear during the teenage growth spurt period. The pain becomes worse with vigorous physical activity and exercises. Sometimes, the pain may feel like a muscle strain.

Causes

Spondylolysis occurs because of a defect or stress fracture in the pars interarticularis, the part of the lumbar spine joining the upper and lower joints. Genetic factors may have a role. Children born with thin vertebra are prone to vertebral stress fractures. Also, repetitive trauma to the lower back area that occurs during sports and other activities can cause weakness of the pars interarticularis, resulting in spondylolysis.

Risk Factors

Risk factors for developing spondylolysis include:

  • Family history of back problems,
  • Repetitive trauma to the lower back,
  • Increased lordosis (swayback),
  • Incomplete development of spinal cord (spina bifida occulta), and
  • Participation in sports such as football, gymnastics and weight lifting that require constant overstretch.

Complications

Untreated spondylolysis may lead to further complications including:

  • Spondylolisthesis, a condition where one or more vertebrae slips out of place
  • Limited mobility and inactivity
  • Weight gain because of inactivity
  • Loss of bone density
  • Loss of muscle strength
  • Loss of flexibility
  • Permanent nerve damage
  • Chronic back pain
  • Numbness, tingling or weakness in the legs
  • Nerve compression causing problems with bowel or bladder control

Diagnosis

Your physician will diagnose the condition based on the following factors:

  • Family History: As spondylolysis is genetically related, family patterns are helpful to diagnose the condition.
  • Medical History: You will be asked about any related medical conditions of your child that could be contributing to the condition.
  • Physical Examination: The physical examination helps to identify and to rule out conditions with similar symptoms.
  • X-ray: X-ray of the spine is taken to look for defects or fractures.

 

  • CT scan or MRI scan: May be needed to detect very small fractures, and other conditions causing pain.

 

Treatment

Primary treatment for spondylolysis is always conservative. The goal of the conservative treatment is to reduce the pain, allow the fracture to heal and improve the function.

Conservative treatment options include:

  • Rest
  • Medications
  • Physical therapy
  • Use of braces

Rest

Adequate rest should be taken and strenuous exercises should be avoided until the symptoms subside.

Medications

Nonsteroidal anti-inflammatory drugs (NSAID’s) may be prescribed to reduce the pain and inflammation.

If NSAID’s do not provide relief, epidural steroid injections may be administered to the spine to reduce pain, numbness and tingling in the legs.

Physical therapy

An exercise program helps to strengthen the abdominal and back muscles, improve flexibility and increase range of motion of the lower back.

Use of Braces

In severe cases of spondylolysis, a brace or back support may be used to stabilize the lower back during fracture healing.

Surgical treatment

Surgery is usually required if spondylolysis causes slippage of the vertebra, a condition called spondylolisthesis.

The goal of the surgery is to remove any abnormal bone compressing a nerve and to stabilize the spine.

Decompressive Laminectomy

This is a surgical procedure in which a portion of the bone or lamina causing pressure on the nerves is removed. A surgical incision is made in the back, then part of the bone and thickened tissue pressing on the spinal nerves is removed. This allows more space for the nerves thus relieving pain and pressure. This procedure makes the spine unstable therefore another procedure called a spinal fusion will also be performed to stabilize the spine.

Spinal Fusion

This is a surgical technique used to join two bones in the spine.

In spinal fusion, a piece of bone, taken from elsewhere in the body or donated from a bone bank, is transplanted between the adjacent vertebrae. As healing occurs, the transplanted bone fuses with the spine. This stimulates growth of a solid mass of bone which helps to stabilize the spine. In some cases, metal implants such as rods, hooks, wires, plates or screws are used to hold the vertebra firm until the new bone grows between them.

Prevention

Although spondylolysis is not completely preventable, certain factors can reduce the risk of developing the condition:

  • Maintaining a healthy weight to reduce stress on the lower back
  • Core exercises to keep the abdominal and back muscles strong will help to support the lower back
  • Eating a well-balanced diet to keep your bones strong

Spondylolisthesis

The spine consists of vertebral bones stacked one on top of the other that surround and protect the spinal cord. Spondylolisthesis is a condition in which a vertebral bone slips out of place in relation to the one beneath it. This causes misalignment and narrowing of the spinal column, a condition called spinal stenosis, which can put pressure on the nerves, resulting in pain in the lower back, buttocks or legs with walking or standing.  As the spine tries to stabilize itself, the joints between the slipped vertebra and adjacent vertebrae can become enlarged, pinching the nerves as they exit the spinal column.

Causes

Spondylolisthesis generally occurs after the age of 50 from osteoarthritis or age-related wear and tear of cartilage in the vertebral joints. It usually involves the spine in the lower back and affects women more frequently. Spondylolisthesis can also occur as a birth defect or due to an injury in children and young adults.

Signs and Symptoms

Symptoms of spondylolisthesis can include pain in the back, legs or buttocks, electrical shock sensations that travel down the leg, and numbness, a tingling sensation or weakness in the legs. If spondylolisthesis occurs in the lumbar or lower back area, the sciatic nerve may be compressed. This is a long nerve that begins in the lower back and extends through the buttocks down the back of each leg to the thighs and feet. Compression of the sciatic nerve causes a painful condition called sciatica.

Diagnosis

To diagnose spondylolisthesis, your doctor will review your symptoms and perform a physical examination. People with spondylolisthesis find it difficult to raise the leg on the affected side forward. Imaging studies are obtained to visualize the affected region of the spine.

Treatment

Spondylolisthesis is treated according to the degree of pain and how far the vertebra has shifted out of position. Non-surgical treatment may be recommended to relieve symptoms and help the vertebra return to position. This can include physical therapy, the use of a back brace, anti-inflammatory medications or steroid injections. You are advised to avoid strenuous activity or contact sports until you heal properly. If pain due to nerve compression is severe or persistent or if the vertebra has shifted far out of place, your doctor may recommend surgery. The goal of the surgery is to remove any abnormal bone that compresses a nerve and to stabilize the spine. Adjacent vertebral bones are usually fused to improve stability and minimize pain.