Spondylolysis is a defect in the pars interarticularis, the portion near the joints between two vertebrae bones in the back.
Spondylolisthesis is the term to describe the forward slipping of a bone (vetebrae) over another beneath it in the spine.
Both these conditions most commonly occur in the lower back and hence are often found in people who suffer from lower back pain. Spondylolysis can occur on its own, and can cause the bones to slip forward causing spondylolisthesis.
Symptoms
These conditions can be asymptomatic and are sometimes found incidentally in scans for other non-related issues.
Low back pain aggravated by activity is the most common symptom experienced in these conditions.
References
Hu, S. S., C. B. Tribus, et al. (2008). “Spondylolisthesis and Spondylolysis.” The Journal of Bone & Joint Surgery 90(3): 656-671.
Causes
Spondylosis and spondylolisthesis are associated with athletic activities such as football, gymnastics, wrestling, volleyball, and weightlifting.
References
Kalichman, L., D. H. Kim, et al. (2009). “Spondylolysis and Spondylolisthesis: Prevalence and Association With Low Back Pain in the Adult Community-Based Population.” Spine 34(2): 199-205.
Risk Factors
Mechanical factors are known to trigger these injuries but the factors that predispose an individual to the injury over another is currently not well understood.
Some risk factors that are thought to predispose to spondylolysis and spondylolisthesis include:
- Adolescence, especially if injury occurs during growth spurts.
- Females.
- Pregnancy.
- Osteoarthritis – can lead to degenerative spondylolisthesis in older people.
- Diabetes – more prone to degenerative spondylolisthesis.
- Traumatic injury – an injury that does not heal properly in an adolescent can progress to spondylolisthesis.
- Sports that require continous hyperextension of the lower back eg gymnastics.
Investigations
History and Examination
If you have pain, the doctor will ask you more about it – where and how long has it been there, what make the pain worse or better. He or she will also ask you about your past medical history, the medications you take and what could have caused the injury to your back.
He or she will then examine the area of pain in the back and ask you to perform a serious of movements around the hips and throughout the legs to test for strength and range of motions.
Investigations
- Xray of the back
- CT scan
- MRI
Complications
Progression of spondylolysis or spondylolisthesis is indicated by:
- Cauda equina syndrome
- Severe worsening back & leg pain
- Severe leg weakness
- Postural deformity
- Gait abnormality
Treatment
Non-surgical treatment
Conservative management will often be tried as the initial treatment as it is the most safe and is effective for most people. This will include:
- Advice – this will vary depending on the extend of your injury. Rest is suggested during a flare up of the pain but otherwise non-aggressive exercise is recommended. High-impact sports should be avoided.
- Physiotherapy – a physiotherapist will take you through a series of exercises that will help strengthen the muscles in the back and stabilise the spine to manage your symptoms.
- Medication – used for short periods of time to ease the pain and muscle spasms to aid return to normal activities.
Surgical Treatment
Surgery is only necessary if the above measures fail and your pain is excruciating and preventing you from carrying on with your normal activities.
- Nerve decompression involves removing a section of bone from the back of the spine to free up the compressed nerves that are the cause of your symptoms.
- Fusion surgery involves fusing two or more vertebrae bones to stabilise the spine.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to:
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
- If you are aware that it runs in your family, be careful with your lower back. Try to avoid high risk activities and try not to put too much stress on your lower back.
- Try to do sports in a safe environment, e.g. land on proper mats when doing gymnastics, play football on grassfields.
- Maintain good posture.
F.A.Q. | Frequently Asked Questions
Is surgery compulsory?
No, surgery is not necessary in all cases. Where medication and physiotherapy fail to provide relief, surgery is done in those cases.
Will I be able to return to work after the surgery?
We would advice gradual return to strenuous activity. It also depends on what kind of work you do. Most people will be able to start walking up and about 10 days after the surgery. However, it is recommended to limit to light movements within the house in the first month. If your job is sedentary, you may be able to return to work after a month provided you do not travel for a prolonged periods of time on bumpy roads. If your job involves moderate labour, you should be able to return to work after 3 months. If you are involved in heavy manual labour, it would be wiser to seek some job modifications. Discuss with your doctor as he or she will know your situation well. It is not recommended that you take more than 3 months off work as activity is important for recovery as well.