Spondylolysis / Spondylolisthesis


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.  

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, this defect most often represents a stress fracture caused by overuse. It is most common in sports that involve repetitive extension and loading of the low back such as gymnastics, diving, volleyball, softball pitching, weight lifting, 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, usually during the adolescent growth spurt. Trauma is an extremely rare cause of slippage. 

What are the symptoms of Spondylolysis/Spondylolisthesis? 

The symptoms of spondylolysis and spondylolisthesis are very similar. The main symptom is pain in the low back that is worse with spine extension and with impact activities such as running and jumping. The pain may radiate to the buttocks and thighs. Muscle spasms often occur in response to the injury. These spasms can make the condition more painful and cause awkward posture and gait. 

Diagnosing Spondylolysis/Spondylolisthesis 

The diagnosis is often suspected based on history and physical examination of the back and legs. An X-ray may identify spondylolysis, but it is not the most sensitive test. Therefore, if the symptoms and physical examination suggest spondylolysis but the X-ray does not show a defect, the doctor may recommend a bone scan or CT scan, which are more sensitive tests. An MRI might be ordered if the doctor is suspicious for a confounding soft tissue injury such as a disc herniation.  

Treatment for Spondylolysis/Spondylolisthesis 

The treatment starts with a period of rest from all sports and activities to allow the stress fracture to heal. A back brace may be prescribed to limit spine movement in order to help relieve pain and promote healing. Ice and pain reliever medications may help reduce back pain that is not relieved with rest and bracing. 

Once the initial healing period is over and the pain has subsided, the doctor 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 strengthening and stretching program is designed to reduce tension on the injured vertebra and stabilize the lumbar spine. This helps reduce the risk for re-injury. 

For spondylolisthesis, periodic X-rays may be performed to evaluate whether the vertebra is continuing 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 that do not respond to this treatment, surgery may be necessary for relief of symptoms. 

Prevention 

  • 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 low back and increase the 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 required to allow time for the injured area to heal. If pain does not resolve after a couple days of rest, consult the doctor. The sooner an injury is identified, the sooner proper treatment can begin. The result is shorter healing time and faster return to sport. 

Spondylolysis/Spondylolisthesis by the numbers: 

  • The most common location for spondylolysis is the 5th lumbar vertebrae, accounting for approximately 85% of cases 
  • In the adolescent athlete, spondylolysis is the cause of pain in an estimated 47% of athletes complaining of back pain 

Research:

  • Cassidy RC, Shaffer WO, Johnson DL. Spondylolysis and spondylolisthesis in the athlete. Orthopedics. 2005 Nov;28(11):1331-3. 
  • Anderson SJ and Harris SS, eds. Care of the Young Athlete, 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2010. 
  • Sarward JF and LaBella CR, eds. Pediatric Orthopaedics and Sports Injuries. Elk Grove Village, IL: American Academy of Pediatrics; 2010.