Spondylolysis is the diagnostic term describing tiny fractures in the pars interarticularis bones of the spine. Spondylolysis is the most common cause of spondylolisthesis, the slippage of one vertebral bone over the one beneath. Although either of these disorders can be found anywhere in the spine, the lower back is predominantly affected, probably due to the increased weight that this area has to bear.
The vertebrae, or bones of the spine, are separated by discs which act as shock absorbers and allow movement of the spine in several directions. Part of the vertebrae include facet joints at the back of the spine and, attaching the joints, are small arched bones called the pars interarticularis.
If the pars become sufficiently damaged, they may no longer be able to hold the vertebrae in place, which can cause spondylolisthesis. Such damage also increases the stresses and forces that the intervertebral discs have to withstand, which may lead to conditions such as sciatica.
Spondylolysis is commonly found in young athletes whose particular sport necessitates regular hyperextension of the lumbar spine (lower back). Gymnasts are a good example, although the condition is found amongst athletes participating in many other sports. Spondylolysis can be diagnosed as active or inactive. The condition is not always dangerous, and does not necessarily lead to spondylolisthesis, but, if active, it does require careful treatment to avoid incorrect healing, which might lead to chronic or recurrent back problems.
Spondylolisthesis damage can occur on one or both sides of the spine. It is usually found between the fifth lumbar and the first sacral vertebrae, although it can also be found between the fourth and fifth lumbar vertebrae. It is rarely found higher in the spine. It is graded accordingly to severity, with 1 being the mildest, and 5 the most severe, in which instance the vertebra has completely slipped off the one below.
Spondylolysis and Spondylolisthesis Causes:
It is believed that 3-7% of the population has this condition, but it is not understood what will cause it in one person rather than another. Common causes are:
Repeated overextension of the lumbar spine, resulting in degeneration and fractures of the pars interarticularis.
Normal aging, leading to degeneration of the spine.
Spondylolysis. As the facet joints are no longer held in correct position by the pars interarticularis, the slippage of one vertebra over another can occur.
Tumor of the spine
Spondylolysis and Spondylolisthesis Symptoms:
This condition can be present without any symptoms being felt, but there might be:
Pain in the lower back following some sort of trauma, particularly when experienced by adolescents who engage in sports.
Leg pain that prevents normal activity.
Pain in the lower back that might radiate to the buttocks or back of thigh, or perhaps to below the knee, occasionally to the foot.
Pain that is worse when standing, walking or bending backwards.
Pain that is better when sitting or, particularly, reclining.
Legs which feel very tired, especially after walking.
If the spondylolisthesis is more severe, symptoms might include:
Visible deformity of the back such as a short torso and large abdomen.
Sway back (lordosis) and a pelvis that is tilted vertically.
Such tight hamstrings that the gait is affected and a 'waddle' develops.
Rarely, a condition called cauda equina syndrome occurs when the nerve bundle in the spinal canal is compressed by the vertebral slippage. This is serious and, if suspected, immediate medical attention should be sought. The symptoms include:
Numbness or weakness in the legs that becomes progressively worse.
Unusual feeling in the 'saddle' area, the buttocks, inner thighs and rectal area.
Sudden loss of control of the bladder and bowels.
Spondylolysis and Spondylolisthesis Diagnosis:
When any young athlete complains of pain in the lower back after some sort of trauma, spondylolysis must be suspected.
A particular test is known as Michelis' test. The patient stands on one leg in a position that hyperextends the lower (lumbar) spine. The position is repeated while standing on the other leg. If pain is experienced, the diagnosis might be active spondylolysis. An x-ray would probably be taken to confirm the diagnosis and to see if one or both sides of the spine are affected. To determine whether the condition is active or not, an MRI (magnetic resonance imaging) or SPECT (single photon emission computed tomography) scan will probably be taken. If it is active there will likely be pain in the low back; if inactive, any pain will probably be coming from a different source.
Spondylolysis and Spondylolisthesis Treatment:
Many people worry that continuing with sports or activities after treatment for spondylolysis will trigger spondylolisthesis, with danger of permanent damage or even paralysis. This has not been proved to be the case.
Bracing of the back for about 4 months, to immobilize the lower spine and allow the pars interarticularis to heal, is considered an effective treatment. For the treatment of spondylolisthesis, the best success is experienced when bracing is used in the early stages.
Cold and heat application to the area. Apply an ice pack for up to 20 minutes at a time, several times a day. When the pain has ceased, apply heat in the same manner.
Pain medications such as acetaminophen (Tylenol) and/or NSAIDs such as ibuprofen (Advil), Aleve or aspirin to alleviate inflammation.
Corticosteroid injections to the site can lessen pain and allow other therapies to take place.
Surgery is not usually needed, as time and non-surgical treatments are normally effective. However, if the back is not healing, or there are nerve-related complications, surgery might become necessary.
Bracing is not needed. Often the disorder is discovered after fractures in the pars have already healed, in which case there might be recurrent or chronic low back pain.
Any further slippage of the vertebrae is highly unlikely.
Physiotherapy, chiropractic or osteopathy treatments will probably not help reduce the slippage, but may relieve pain caused by stresses on the facet joints.
Exercise, beginning with gentle hamstring stretches and gradually including other stretches and strengthening positions.
What to look for in a brace to help with spondylolysis or spondylolisthesis:
A brace providing strong support will be useful. Gently compressing the abdomen with a brace lessens weight on the spine, thereby relieving pressure and allowing healing to take place. You may find a brace made with breathable fabric comfortable.
Spondylolysis and Spondylolisthesis Prevention:
Unfortunately, once a back has suffered damage the likelihood of further problems is increased, so it is extremely important to take extra care. Lifestyle changes may have to be made in order to reduce the risk of trauma or excessive strain on the back.
Exercise regularly to build up muscle strength and improve flexibility.
Maintain good posture.
Maintain a healthy weight.
If you smoke, stop.