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Back Pain

Spondylolisthesis is a condition in which a vertebra located in the lumbar spine (lower back) cannot maintain its position and slips forward onto a bone below.  If the vertebra slips too far, there may be nerve impingement or nerve damage.  The condition ranges from very mild (no symptoms apparent) to severe (resulting in nerve damage).  Spondylolisthesis is most commonly seen in adolescent athletes.



What is Spondylolisthesis?

Spondylolisthesis is a condition in which a vertebra located in the lumbar spine (lower back) cannot maintain its position and slips forward onto a bone below.  If the vertebra slips too far, there may be nerve impingement or nerve damage.  The condition ranges from very mild (no symptoms apparent) to severe (resulting in nerve damage).  Spondylolisthesis is most commonly seen in adolescent athletes.


What causes Spondylolisthesis?

There are a number of different causes of spondylolisthesis, including birth defects affecting the spine, degenerative diseases, bone diseases, and stress and traumatic fractures of the spine.  Family history may result in a higher likelihood of developing the condition.  In adolescent athletes, sports that put a lot of stress on the lower back or require constant hyperextension of the back (as in gymnastics) may cause stress fractures of the vertebrae in the lower spine that can then lead to slippage of the vertebrae.  


What are the symptoms of Spondylolisthesis?

Spondylolisthesis may produce symptoms such as pain in the lower back, buttocks and thighs, as well as tenderness, stiffness and muscle tightness in the hamstrings.  Changes to gait and posture may be apparent.  In more severe cases, nerve damage may occur, causing radiating pain down the legs.  Some people with the condition, however, experience no symptoms.  Spondylolisthesis can produce swayback (lordosis) and roundback (kyphosis).


How is Spondylolisthesis diagnosed?

A medical professional will perform a physical exam and will ask the individual to raise their leg straight up in the air.  If a vertebra has slipped, this will cause pain or be difficult to do.  They will also ask questions about the types of activity the individual engages in on a regular basis and will ask about any symptoms experienced.  X-rays will show whether a disc has slipped or if there are other causes of pain, such as a fracture.  If the vertebra is pressing on the nerves, an MRI or CT scan may be recommended before treatment begins.


When should I seek care for Spondylolisthesis?

If you or your child experience pain or stiffness in your lower back, buttocks or thigh, or have tightness in your hamstrings and a back that appears curved, you should seek medical care.  Early diagnosis and treatment can help you avoid permanent nerve injury or worsening of the condition.


What will the treatment for Spondylolisthesis consist of?

Treatment for spondylolisthesis varies depending on how severe the condition is.  In mild cases, physical therapy, strengthening and stretching exercises help the condition, coupled with avoiding certain activities such as contact sports and any activity that may hyperextend the back.  Anti-inflammatory medications may help ease pain.  A rigid back brace may be recommended to support the spine and periodic x-rays may be recommended to monitor the position of the slipped vertebrae on an ongoing basis.  With more severe cases, or if there is severe pain or nerve injury, spinal fusion surgery may be recommended.  Surgery is a last resort option and carries with it the complication of nerve injury.


Which muscle groups/joints are commonly affected by Spondylolisthesis?

Spondylolisthesis occurs in the lower part of the back but may cause pain or weakness in the legs (thighs and hamstrings) or buttocks as well.


What type of results should I expect from the treatment of Spondylolisthesis?

Non-surgical treatments, including exercises, avoidance of certain activities, and wearing a rigid back brace are successful in treating the symptoms of spondylolisthesis around 80% of the time.  For those with more severe cases of the condition that require surgery, the success rate is slightly higher but the surgery does carry with it some danger of nerve injury.

 

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