Spondylolisthesis

What Is Spondylolisthesis?

Spondylolisthesis (spon-duh-low-lis-THEE-sis) happens when the front part of a vertebra (bone in the spine) slides away from the back part. In kids and teens, it's often a complication of spondylolysis, and is a common cause of lower back pain in these age groups.

Mild cases of spondylolisthesis heal with rest and other "conservative" (or nonsurgical) treatments. Sometimes, the condition can be severe and may need surgery to fix it.

How Does Spondylolisthesis Happen?

The spine (or backbone) has 33 bones called vertebrae (VER-tuh-bray). Nine vertebrae are fused together to form the tailbone, and the other 24 are in the back. The lumbar vertebrae are in the lower back and closest to the tailbone. This is where spondylolisthesis usually happens.

Sometimes the front and back parts of one of the vertebra aren't connected. This happens because of a spondylolysis, or fracture (break) in the part of the vertebra called the pars (or pars interarticularis). Each vertebra has two pars, one on the left side and one on the right. If both pars are fractured, the front part of the vertebra can slide away from the back part.

Most of the time, the front slides away only a little bit. But if it slides away a lot, it can cause the spinal cord and nerve roots to become pinched.

Some kids are born with a spondylolisthesis and some cases probably are genetic (passed down by parents to their children). Spondylolisthesis can get worse while kids are growing and even into adulthood.

What Are the Signs & Symptoms of Spondylolisthesis?

Many people with spondylolisthesis don't realize that they have it. Their backs might feel just fine despite a vertebra being out of place.

When there are symptoms, they often include:

• pain in the lower back that might feel like a muscle strain
• pain in the thighs and buttocks
• stiff muscles and tenderness in the lower back
• muscle tightness, especially in the hamstring muscles

If the vertebra slips far enough to press on the spinal cord or smaller nerves, it can cause increased pain and, in more serious cases, nerve damage. Signs of this include:

• pain that radiates down the legs
• weakness in the legs or trouble walking
• trouble peeing or bladder accidents
• numbness and tingling in the groin and/or buttocks

Young people are more at risk for spondylolysis and spondylolisthesis because their bones are still growing, especially during a growth spurt.

Kids and teens who play sports and do activities that can strain the lower back or that involve a lot of lower-back stretching — like football, weightlifting, gymnastics, volleyball, ballet, golf, and wrestling — have a higher risk for spondylolisthesis.

How Is Spondylolisthesis Diagnosed?

Besides doing an exam, health care providers will order X-rays of the lower back to look for spondylolisthesis. X-rays can show if a vertebra has slipped out of place.

Sometimes, they order other imaging tests — such as a CT (computed tomography) scan or a lumbar MRI scan — to get a better look at the back and to see if the slipped vertebra is affecting the nerves.

How Is Spondylolisthesis Treated?

Most people with spondylolisthesis get better by resting and doing exercises designed to stretch and strengthen the back. Only in severe cases is surgery needed to fix the condition.

As with spondylolysis, health care professionals probably will recommend:

• a break from sports and other strenuous activities
• plenty of rest
• core-strengthening exercises that don't strain the lower back
• flexibility training
• physical therapy
• over-the-counter (OTC) medicine to help ease pain and swelling

Conservative treatments usually are enough to fix the pain from spondylolisthesis.

For more severe cases, a surgical procedure might be needed. In surgery:

• The bone that slipped forward is moved back into place (this is called a reduction).
• Another piece of the vertebra is removed to take pressure off the nerves (this is called a decompressive laminectomy).
• Rods and screws are put in to hold the spine in place while it heals and the bones fuse together, making them more stable (this is called a spinal fusion).

What Problems Can Happen?

If spondylolisthesis that causes symptoms isn't diagnosed and treated, kids can have chronic back pain and a loss of flexibility. In some cases, the degree of slip can worsen over time.

Can Spondylolisthesis Be Prevented?

Spondylolisthesis is hard to prevent because it can happen all at once or over time. A child or teen who has spondylolysis can help prevent it progressing to spondylolisthesis by taking the time to rest and heal as the health care provider directs.

Young athletes can help lower their risk of these and other back problems by:

• limiting time spent on high-risk sports
• resting and recovering after physical activities
• keeping core muscles strong
• warming up properly before playing any sports
• stretching regularly
• using safety equipment correctly
• following the rules and techniques for their sport or activity
• maintaining a healthy weight

What Else Should I Know?

The sports and activities that can cause spondylolysis and spondylolisthesis often are very competitive and attract motivated, driven kids and teens. So it's important to keep your child's temperament in mind when dealing with these problems and their recovery.

Besides their own wishes to return to what they love, kids and teens also might be under pressure to get back into the game from coaches, teammates, and even parents. But a safe return to play is very important. Kids should get the OK from their health care provider before they return to physically demanding activities and sports.

After recovery, kids and teens need to keep up with the proper techniques and sports safety measures they learned. They should maintain their core strength and flexibility, and take breaks between sports seasons, games, and competitions. Pain from spondylolysis and spondylolisthesis can return if kids do not properly maintain core strength and flexibility.

Also, be sure that your kids know to immediately stop doing any activity that causes back pain. They should see their health care provider and not return to play until the pain goes away.