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Spondylolisthesis
(spon-dee-low-lis-thee-sis)
Are you
experiencing back pain as a result of spondylolisthesis
or another spinal condition? The specialists at United Spine
& Joint can help with a treatment plan.
Contact us to determine
what treatment option is best for you, what your insurance
will cover and any additional surgery costs.
What is Spondylolisthesis?
The most common cause of
low back pain in adolescent athletes that can be seen on
X-ray is a
stress fracture in one of the bones (vertebrae) that
make up the spinal column. Technically, this condition is
called spondylolysis. It usually affects the fifth lumbar
vertebra in the lower back and, much less commonly, the
fourth lumbar vertebra.
If the stress fracture weakens the bone so much that it is
unable to maintain its proper position, the vertebra can
start to shift out of place. This condition is called
spondylolisthesis. If too much slippage occurs, the
bones may begin to press on nerves and surgery may be
necessary to correct the condition.
Cause of Spondylolisthesis
Genetics
There may be a hereditary aspect to spondylolysis. An
individual may be born with thin vertebral bone and
therefore may be vulnerable to this condition. Significant
periods of rapid growth may encourage slippage.
Overuse
Some sports, such as gymnastics, weight lifting, and
football, put a great deal of
stress on the bones in the lower back. They also require
that the athlete constantly overstretch (hyperextend) the
spine. In either case, the result is a
stress fracture on one or both sides of the vertebra.
In many people, spondylolysis and spondylolisthesis are
present, but without any obvious symptoms. Pain usually
spreads across the
lower back and may feel like a
muscle strain.
Spondylolisthesis can cause spasms that stiffen the back
and tighten the hamstring muscles, resulting in changes to
posture and gait. If the slippage is significant, it may
begin to compress the nerves and narrow the spinal canal.
Diagnosis of Spondylolithesis
X-rays of the lower back (lumbar) spine will show the
position of the vertebra. The pars interarticularis is a
portion of the lumbar spine. It joins together the upper and
lower joints. The pars is normal in the vast majority of
children.
If the pars "cracks" or fractures, the condition is called
spondylolysis. The X-ray confirms the bony abnormality.
If the fracture gap at the pars widens and the vertebra
shifts forward, then the condition is called
spondylolisthesis. Usually, the fifth lumbar vertebra shifts
forward on the part of the pelvic bone called the sacrum.
The doctor measures standing lateral spine X-rays. This
determines the amount of forward slippage.
If the vertebra is pressing on nerves, a CT scan or MRI may
be needed before treatment begins to further assess the
abnormality.
Nonsurgical Treatment of Spondylolithesis
Initial treatment for spondylolysis is always nonsurgical.
The individual should take a break from the activities until
symptoms go away, as they often do. Anti-inflammatory
medications, such as ibuprofen, may help reduce back pain.
Occasionally, a back brace and physical therapy may be
recommended. In most cases, activities can be resumed
gradually and there will be few complications or
recurrences. Stretching and strengthening exercises for the
back and abdominal muscles can help prevent future
recurrences of pain.
Periodic X-rays will show whether the vertebra is
changing position.
Surgical Treatment for Spondylolithesis
Surgery may be needed if slippage progressively worsens or
if back pain does not respond to nonsurgical treatment and
begins to interfere with activities of daily living. A
spinal fusion is performed between the lumbar vertebra
and the sacrum. Sometimes, an internal brace of screws and
rods is used to hold together the vertebra as the fusion
heals.
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