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Understanding Spondylolysis & Spondylolisthesis

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Understanding Spondylolysis & Spondylolisthesis Understanding Spondylolysis & Spondylolisthesis What is Spondylolysis and Causes Symptoms Spondylolisthesis? Genetics In many people where spondylolysis and There may be a hereditary aspect to spondylolisthesis are present, there are The pars interarticularis is spondylolysis. An individual may be born with not any obvious signs or symptoms. No a portion of the lumbar thin vertebral bone and therefore may be treatment is necessary in these cases. spine that joins the upper vulnerable to this condition. Significant periods Pain usually spreads across the lower back and lower joints together. of rapid growth may encourage slippage. and may feel like a muscle strain. The pars is normal in the Overuse Pain may occur only sporadically or may majority of children. Some sports, such as gymnastics, weight be continuous. Sporting activities may Pars lifting, and football, put a great deal of stress exacerbate the pain. Pain on hyperextension Interarticularis on the bones in the lower back. They also is a classic sign for a possible spondylolysis require that the athlete constantly hyperextend or spondylolisthesis. the spine. However, all athletes with spondylol- Spondylolisthesis can cause spasms that Spondylolysis is a stress ysis are at risk of developing low back pain. stiffen the back and tighten the hamstring fracture in one of the muscles, resulting in changes to posture vertebrae that make up the The adolescent with lumbar back pain may have and gait. If the slippage is significant, it spinal column. It usually multiple reasons other than overuse or "growing may begin to compress the nerves and affects the fifth lumbar pains" for the discomfort. (Table 1) narrow the spinal canal leading to leg pain vertebra in the lower back and possible bowel or bladder problems. or, much less commonly, Metabolic: Juvenile osteoporosis Spondylolysis the fourth lumbar vertebra. Examination Inflammatory: Ankylosing Spondylitis Sero-negative Arthritis The clinical examination provides infor- mation about the location of the pain, mus- Spondylolisthesis occurs if Neoplasm: Osteoid osteoma cle spasm, lumbar spine range of motion, the stress fracture weak- hamstring muscle tightness, muscle strength ens the vertebrae so much Congenital: L5-S1 facet Hypoplasia in the legs, reflexes, and sensation in the that it is unable to main- legs and feet. Developmental: Lumbar Scheurmann's tain its proper position and The doctor measures standing lateral spine shifts forward out of place. Trauma: Pars interarticularis X-rays. This determines the amount of Stress fracture forward slippage. If spondylolysis is suspected, your orthope- Spondylolisthesis dist may order a bone scan to help further Diagnostic Imaging May Include: evaluate the stress fracture. X-rays may discount several of the potential Plain x-ray If the vertebra is pressing on nerves, a CT diagnoses and direct the physician to propose 3 phase bone scan with SPECT imaging scan or MRI may be needed before treat- the diagnosis of a pars interarticularis stress MRI ment begins to further assess the abnormal- injury or fracture. CT Scan ity. Treatment Options Each child is different, and your physician will Jeffrey B. Neustadt, M.D. suggest the best treatment option for the child. Gregory V. Hahn, M.D. These include: Drew E. Warnick, M.D. Paul L. Benfanti, M.D. Observation Lee G. Phillips, M.D. Spondylolysis & Continually observing a small stress fracture to Daniel C. Bland, M.D. check for progression as the child or adolescent T. Cooper Wilson, M.D. Spondylolisthesis grows. Bracing Your orthopedist may recommend bracing to help stabilize the spine and allow the spondylolysis to heal. This light weight brace may be worn full time for up to 12 weeks. Physical therapy may follow bracing depending on each patients personal needs. Surgery 625 6th Avenue South, Suite 450 Surgery is performed in only the St. Petersburg, FL 33701 most severe cases. This may be Phone: (727) 898-2663 - Fax: (727) 568-6836 needed if slippage progressively worsens or if back pain does not 3440 W. Dr. MLK Jr. Blvd, Suite 200 respond to non-surgical treatment Tampa, FL 33607 and begins to interfere with Phone: (813) 879-2663 - Fax: (813) 872-0286 activities of daily living. For spon- dylolisthesis, a spinal fusion is 5881 Rand Blvd performed between the lumbar vertebra and Sarasota, FL 34238 the sacrum. This involves placing a system of screws and rods to stabilize the spine, and may 4443 Rowan Road involve a trans-laminar inter-body fusion as New Port Richey, FL 34653 well. Spondylolysis surgery may be limited to actual repair of the fracture. 3850 Tampa Road Palm Harbor, FL 34684 www.chortho.com Updated 10/2017 .
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