Spondylolysis and Spondylolisthesis

Spondylolysis and Spondylolisthesis

Probably the most prevalent cause of lower back pain in young athletes is a stress fracture of the lower back (lumbar) spine. These stress fractures usually affect the 5th lumbar vertebrae, and less so, the 4th lumbar vertebrae.

At times, the vertebra is weakened due to the fracture and is thereby not able to hold its alignment and positioning. This will cause the vertebra to shift out of alignment. If the degree of movement is sufficient enough, the vertebrae will compress on the neural column and will most probably require surgery to correct it.

There are 2 main causes of Spondylolysis and Spondylolisthesis:

1. There seems to be a genetic component Spondylolysis. Some people tend to be born with thinner vertebral spines and thereby more vulnerable to this condition. Sudden growth spurts may also accelerate slippage of the vertebrae.

2. Overuse load is evident in various sports, such as gymnastics, football, weight lifting and this overloading puts excessive load through the lower back. Hyperextension of the back is also necessary in these sports which are another main contributor to a stress fracture. Either or both of these repeated actions can result in a stress fracture on one or both sides of the vertebrae.

The following is important to remember:

• Spondylolysis and Spondylolisthesis can be prevalent in many people but with no apparent symptoms.
• The pain experienced usually spreads across the lower back and can feel like a muscle spasm.
• Spondylolisthesis can result in spasms that stiffen the lower back and tighten the hamstrings. This in turn will affect one’s posture and gait. If the slippage is severe enough, it can compress on the nerves and result in a narrowed spinal canal.

What treatment is available?

Initial treatment should always be conservative and nonsurgical. Rest from all relevant activities till the symptoms have completely subsided is essential for one’s recovery. Anti-inflammatory medication, as prescribed by your medical practitioner, will help reduce the lower back pain experienced.

Once the individual is out of the acute phase, physical therapy is recommended. This should be done gradually to minimise any complications or recurrences. A preventative mobility and strengthening programme focusing on the correct musculature should be adhered to prevent future episodes (especially as if there is a genetic component, chances are it will occur again). This programme will ensure alignment and muscular activation to minimise the load/stress going through the lumbar spine.

Surgical intervention might be necessary if the disc slippage is severe enough to aggravate the spinal nerves. In rare cases, it might also be an option if the stress fracture is not responding to nonsurgical interventions and is affecting one’s daily activities. Surgical intervention is usually done with a spinal fusion between the lumbar vertebrae and the sacrum.