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.
Spondylolisthesis usually is mild and heals with rest and other "conservative"
(or nonsurgical) treatments. However, sometimes it can be severe and need surgery
to fix the problem.
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
Sometimes the front and back parts of one of the vertebra aren't connected. This
happens because of a 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 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
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
Who Gets Spondylolisthesis?
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 — are especially likely
to have these problems.
How Is Spondylolisthesis Diagnosed?
Besides doing a physical 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
Sometimes, other imaging tests are done — 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 rare cases is surgery needed to fix the
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
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 has slipped forward is moved back into place (this is called a reduction).
Another piece of the vertebra is removed to take pressure off of 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
What Can Happen?
If mild spondylolisthesis doesn't heal properly, kids can have chronic back pain
and a loss of flexibility.
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
using safety equipment correctly
following the rules and techniques for their sport or activity
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
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.
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.