Spondylolysis & Spondylolisthesis
The lumbar spine commonly referred to as the lower back, is the part of the spine that curves inwards towards the stomach. The lumbar spine connects with the thoracic spine at the top and extends down to the sacral spine, and is built for flexibility and power, enabling the body to lift, bend, and twist. The spinal cord stops at the point where the thoracic spine meets the lumbar spine and continues to branch out to form the cauda equina, which is a network of nerves that extend to the lower extremities of the body. Since the spinal cord does not run through the lumbar spine, it is rare that an injury to the lower back would result in paralysis or damage to the spinal cord.
Spondylolysis is a stress fracture which occurs most commonly in the fourth or fifth lumbar vertebrae. If the stress fracture weakens the bones to the point where the vertebrae is unable to maintain proper positioning and slips out of place, this condition is called spondylolisthesis. There are several factors that could cause these conditions, but the most common causes are heredity or overuse.
In many individuals, spondylolysis and spondylolisthesis may be present without obvious symptoms, however some of the common symptoms include:
- Pain spread across the lower back that might feel like a muscle strain
- Muscle spasm in the back
- General pain the lower back that worsens with activity
Spondylolysis and spondylolisthesis are diagnosed with a combination of physical examination and imaging studies. After discussing the individual's symptoms, the physician will examine the lower back for points of pain and any visible deformity. The physician will then order an X-ray of the lumbar spine to see the position of the vertebra. If the pars interarticularis, the portion of the lumbar spine that joins the lower and upper joints, has a crack or fracture, spondylolysis is the diagnosed condition. However, if the fracture gap at the pars widens, causing the vertebrae to shift forward, then spondylolisthesis is the diagnosis. If the vertebra presses on nerves, the physician may order a CT or MRI scan to further assess the positioning and associated injury.
Initial treatment for spondylolysis and spondylolisthesis is typically conservative, and non-operative.
Rest - It is advised to decrease or completely stop the activity that makes the pain worse. Often, this is all that is needed to make the symptoms go away in the early stages of spondylolysis. Arching backwards or extension activities should also be avoided during this healing time
Medication - Over-the-counter medication such as NSAIDs may help reduce pain and swelling.
Brace - In some cases, the physician may recommend the use of a brace especially when doing activities involving the lower back.
Physical Therapy - A physical therapist may recommend some stretching and strengthening exercise to prevent further damage and pain.
Surgery - If the non-operative treatments have been exhausted and the slippage of the vertebra progresses, the physician may recommend an operative approach. The exact procedure will vary based on the severity of the condition.
CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!
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