Spondylolysis and Spondylolisthesis (Pediatric)

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What is spondylolysis?

Spondylolysis is a defect in one of the bones (vertebral body) that make up the spinal column. The defect is located in the area of the vertebra called the pars interarticularis, which helps to make up the bony ring through which the spinal cord travels. Spondylolysis is one of the most common causes of low back (lumbar) pain in adolescents.

The most common location for spondylolysis is the 5th lumbar vertebrae and accounts for nearly 85 percent of cases. Spondylolysis is the cause of pain in an estimated 47 percent of adolescent athletes complaining of back pain.

What is spondylolisthesis?

Spondylolisthesis occurs when the spondylolytic defect weakens the vertebrae to the point where it is unable to maintain its proper position with respect to the vertebrae below it, and starts to shift or slip out of place.

What causes spondylolysis?

In athletic children and adolescents, spondylolysis most often represents a stress fracture caused by overuse. It is most common in sports that involve repetitive extension and loading of the lower back such as gymnastics, diving, volleyball, softball pitching, weightlifting, and football. In about 5 percent of the population, spondylolysis develops gradually during normal growth. The defect is due to congenital abnormalities that do not allow fusing bone fragments to unite normally.

What causes spondylolisthesis?

This slippage of one vertebral body on another tends to occur during periods of rapid growth such as adolescent growth spurts. Trauma is a rare cause of slippage.

What are the symptoms of spondylolysis and spondylolisthesis?

The symptoms of these conditions are similar. The main symptom is pain in the lower back that is worse with spine extension and impact activities such as running and jumping. Pain may radiate to the buttocks and thighs. Muscle spasms often occur in response to the injury, making the condition more painful and causing awkward posture and gait.

How are spondylolysis and spondylolisthesis diagnosed?

Our doctors take a patient's medical history and do a physical examination of the back and legs. An X-ray may identify spondylolysis, but it is not the most sensitive test. If the symptoms and physical examination suggest spondylolysis but an X-ray does not show a defect, our doctors may recommend more sensitive tests such as a bone scan or CT scan. An MRI might be done if there's concern of a confounding soft tissue injury such as a disc herniation.

What is the treatment for spondylolysis and spondylolisthesis?

Treatment starts with a period of rest from all sports and activities, so the stress fracture heals. A back brace may be prescribed to limit spine movement, helping to relieve pain and promote healing. Ice and pain reliever medications may also reduce back pain not relieved by rest and bracing.

Once the initial healing period is over and pain has subsided, our doctors will likely recommend a course of physical therapy to include core strengthening, hamstring stretching, and posture training with gradual progression to sports-specific activities. This regimen is designed to reduce tension on the injured vertebra and stabilize the lumbar spine, thereby reducing the risk for re-injury.

For spondylolisthesis, periodic X-rays may be performed to evaluate whether vertebra continue to slip. Most cases of spondylolysis and spondylolisthesis resolve with rest and physical therapy, and athletes are able to return to their sport with no restrictions. For the rare cases unresponsive to this treatment, surgery may be necessary.

How can spondylolysis and spondylolisthesis be prevented?

Preventive measures for children and adolescents are:

  • Strength must be maintained in the abdominal, back, and hip muscles. These muscles help to stabilize the spine and reduce the load on the vertebrae.
  • Tight hamstrings put tension on the lower back and increase risk for back pain. Hamstring stretches are best done after a warm-up or at the end of a practice or game.
  • Maintain a healthy weight.
  • Do not play through pain.

Pain is a sign of injury, stress, or overuse. Rest is needed to allow time for the injured area to heal. If pain does not resolve after a couple days of rest, consult our doctors. The sooner an injury is identified, the sooner treatment begins. The result is a shorter healing time and a faster return to sports.