What is Spondylolysis and Spondylolisthesis?
Spondylolysis or spondylolisthesis refers to a stress fracture of one of the spinal vertebrae. These injuries are a common condition of the lumbar spine that normally occur more in females than males but does occur in both groups. This injury is also commonly seen among youth athletes who participate in sports that involve repeated stress on the lower back such as football, gymnastics, and weightlifting. As a spine doctor, Dr. Ernest Braxton utilizes both conservative and surgical treatment options to help patients recover from spondylolysis.
What are the Differences Between Spondylolysis and Spondylolisthesis?
Spondylolisthesis and spondylolysis are different spinal conditions but they are often related to each other. Spondylolysis is a crack or stress fracture that develops through the pars interarticularis, which is a small, thin portion of the vertebrae that connects the upper and lower facet joints. The pars interarticularis is the weakest part of the vertebrae. Due to this weakness, it is the area most vulnerable to injury from the repetitive stress and overuse. Spondylolysis is most commonly seen at the L4 and L5 levels. When spondylolysis is left untreated it can lead to spondylolisthesis.
Spondylolysis can weaken the vertebrae so much that it is unable to maintain its proper alignment in the spine. In spondylolisthesis, the fractured pars interarticularis separates allowing the injured vertebrae to shift forward onto the vertebrae directly below it. Spine doctors classify spondylolisthesis as either low grade or high grade depending upon the amount of shift. A high-grade shift occurs when more than 50% of the width of the fractured vertebra slips forward on the vertebra below it. Patients with high-grade slips are more likely to experience significant pain and nerve injury and typically need surgery to alleviate pain.
What Causes Spondylolysis and Spondylolisthesis?
Spondylolysis and spondylolisthesis are commonly caused by repetitive lumbar hyperextension. Adolescents who participate in athletics are more susceptible to sustaining a spondylolysis injury. This injury most often occurs during periods of rapid growth—such as an adolescent growth spurt; patients may also have a genetic tendency for this condition.
How Do I Know If I Have Spondylolysis?
In some patients, spondylolysis and spondylolisthesis can be asymptomatic. The conditions may not be discovered until an x-ray is taken for an unrelated injury or condition. Lower back pain is often the first indication of the condition. Patients may also experience:
- Pain in the buttocks that can radiate into the thighs
- Pain that increases with activity and improves with rest
- Stiffness in the lower back
- Tightness in the hamstrings
- Difficulty standing and walking for prolonged periods
How to Diagnose Spondylolisthesis?
Dr. Braxton will diagnose spondylolysis or spondylolisthesis by taking a comprehensive medical history and conducting a thorough physical examination. He will carefully evaluate the back and spine for:
- Location of tenderness
- Restrictions in range of motion
- Muscle weakness and spasms
- Change in posture and gait
- Indication of hamstring impairment
Dr. Braxton may also require imaging tests which could include X-rays, CT scans or MRIs.
Can Spondylolysis be Treated without Surgery?
Most commonly, Dr. Braxton’s conservative treatment option for spondylolysis and spondylolisthesis includes rest to ensure the stress fracture heals. The rest period will include avoiding the sport and other activities that affect the lower back. Other pain relief treatments may include anti-inflammatory medications. Physical therapy may also be used to address hamstring tightness and to strengthen the core muscles of the back and abdomen. Finally, in some cases, patients may benefit from wearing a back brace for a short period of time to stabilize the back.
What is Spondylolysis Surgery?
Spondylolysis surgery is recommended for patients who have:
- Limited improvement after a time of non-surgical treatments
- A shift that is rated at a 50% grade or higher
- Evidence that the shift has worsened over the non-surgical treatment course
Most commonly, fusion surgery is the recommended treatment course. The most common fusion is between the L5 vertebrae and the sacrum. The goal of fusion surgery is to stabilize the affected area of the back and ultimately eliminate painful symptoms of spondylolysis and spondylolisthesis. Physical therapy and follow-up exams will help ensure the best possible outcome for the patient.