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Spondylolysis and Spondylolisthesis

Spondylolysis and Spondylolisthesis

Spondylolysis is the name given to a condition where there is a structural defect such as a crack in one of the vertebrae. Spondylolysis is slippage of one vertebra on another. The structural defect is usually a developmental crack and is present in around 5% of the general population. The defect occurs in the part of the bone referred to as the pars interarticularis which connects the upper and lower joints of every vertebra. This defect can cause the vertebrae to slip on each other giving rise to a spondylolisthesis - hence the close relation of these two conditions. The most common level it is found is at L5-S1.

There are at least 6 recognized causes of slippage as seen in spondylolisthesis in the literature. The most common cause is isthmic spondylolisthesis which usually presents in adolescents or young adults. The most common symptom is back and/or leg pain that limits a patient's activity level.

Treatment

In the past, patients have often been advised to limit their activities to avoid causing advancement of the spondylolysis and often adolescents were pulled from their sports because of fears that their spondylolysis will lead to spondylolisthesis and cause permanent damage or paralysis. There have never been where this has happened and strict prolonged rest is never recommended.

Most pain can controlled with medications like aspirin, ibuprofen, naproxen or acetaminophen. Severe persistent pain may respond to narcotic analgesics (such as codeine) for a short time.

Corticosteroid injections are sometimes undertaken for more severe back and leg pain. These may be in the form of caudal epidurals, nerve root block or pars injection. The initial injection may be followed by one or two more injections at a later date and these are most often done as part of a comprehensive rehabilitation and treatment programme.

Physiotherapy initially focuses on gentle stretches or posture changes to reduce the back pain or leg symptoms. When you have less pain, more vigorous aerobic exercises (such as stationary bicycling or swimming) combined with strengthening/stretching exercises will likely be used to improve flexibility, strength, endurance, and the ability to return to a more normal lifestyle. Developing your back and stomach muscles will help stabilize your spine and support your body. Local therapies like ultrasound, electric stimulation, hot packs, cold packs, and manual "hands on" therapy may help to reduce your pain and muscle spasms.

Surgery is reserved for that small percentage of patients whose pain cannot be relieved by nonsurgical treatment methods. The leg pain may be caused by a pinched nerve whilst movement of the unstable cracked vertebra and abnormal discs and facets cause the associated back pain. Surgery aims to decompress the pinched nerve and in addition to relieving pressure on a nerve around the crack or slippage, a stabilizing procedure or fusion may be performed. This will stop any further slippage of the vertebra and also will prevent recurrent nerve pressure from developing at this site. Occasionally - usually in the young patient the "crack" in the vertebra can be repaired by placing bone graft and screw fixation. The success rate of fusion surgery for relief of isthmic spondylolisthesis is around 75 % with patients returning to work within six to nine months.