Two common causes of low back pain, especially in young athletes, are spondylolysis and spondylolisthesis. Spondylolysis is a crack (stress fracture) through the pars interarticularis of the vertebrae. The pars interarticularis is a small, thin segment of the vertebrae that connects the upper and lower facet joints in the back of the spine. This area is the weakest part of the bone and is very vulnerable to stress injury. Spondylolysis stress fractures commonly occur on one or both sides of the fifth vertebrae of the lower (lumbar) spine, but can also occur in the fourth lumbar vertebrae. This injury can occur in people of all ages but presents most often in adolescent athletes that participate in activities involving repetitive hyperextension of the lower spine, such as gymnastics, weight lifting and football. If left untreated, spondylolysis can weaken the vertebrae causing it to slip out of its normal position. This condition is called spondylolisthesis. In children and adolescents, this slippage happens most frequently during growth spurts.
Symptoms
- Pain may feel similar to muscle strain
- Pain in the center of the low back that radiates down to the buttocks and the back of the thighs
- Pain worsens with activity but improves with rest
- Spondylolisthesis patients may also experience back spasms, stiffness of the back muscles, tight hamstrings and difficulty standing and walking.
- Severe cases may have tingling, numbness or weakness in one or both legs
Causes
- Overuse: Repetitive overstretching of the lower spine (hyperextension) (sports like gymnastics, weightlifting and football).
- Genetics- may be born with thinner vertebrae
Risk Factors
- Children and adolescents are most susceptible
- Participation in activities that require repetitive hyperextension
Diagnosis
- Your doctor will discuss your symptoms, review your medical history, and perform a thorough physical examination of your back.
- The stress fracture can be seen on X-ray, but is often missed. Sometimes a CT or MRI are necessary to diagnose and assess any potential damage to surrounding soft tissue.
- Your doctor may take periodic x-rays during the course of your treatment to determine whether the vertebra is changing position.
Treatment
Most often, the initial treatment for spondylolysis and spondylolisthesis is non-surgical. The majority of patients improve with nonsurgical treatment methods. The goals of non-surgical treatments for spondylolysis and spondylolisthesis are to:
- Reduce pain
- Reduce irritation to the spinal cord and nerves
- Allow for fracture healing
- Return the patient to their normal daily activities
Nonsurgical treatment may include
- Rest from sports and activities that place excessive strain on the lower back.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce swelling, relieve back pain and stop nerve irritation.
- Physical therapy: gentle stretching and strengthening
- Bracing may be necessary to limit movement and allow for fracture healing and inflammation to subside.
A spinal fusion surgery may be recommended when spondylolisthesis patients have
- Severe vertebral slippage
- Progressively worsening slippage
- A period of nonsurgical treatment has failed to improve back pain
The goals of spinal fusion surgery are to
- Prevent further slippage
- Stabilization of the spine
- Alleviate severe back pain
