ISTHMIC SPONDYLOLISTHESIS
The fracture is usually caused by repetitive stress to the lower back of young athletes who participated in sports that require repeated hyperextension, such as gymnastics, ballet, diving, football and weightlifting. The most common place for this to happen is at the very bottom of your spine (L5 lumbar vertebrae.) The fracture itself is called a spondylolysis. This may cause low back pain in a young person, but often pain is not felt until the child reaches adulthood. You can have this condition all your life without knowing it or having pain from it. How is Spondylolisthesis Graded?Spondylolisthesis is graded by how much slippage there is of one back bone over the one below it.• A grade one slippage is less than 25% • Grade two is 25-50% • Grade three is 50-75% • Grade four is greater than 75%. Although very rare, a condition called spondyloptosis can occur, which is where the L5 vertebral body slips off the sacrum and into the pelvis. There also can be a fracture of the pars interarticularis without any vertebral slippage. The forward slippage in spondylolisthesis can become worse in young adolescent individuals.To determine if the spondylolisthesis could get worse in an adolescent an MRI or Bone Scan may need to be performed. After age 16-18 when the bones have pretty much stopped growing there is not usually any further slippage. Isthmic Spondylolisthesis is different from Degenerative Spondylolisthesis which occurs due to the aging process along with significant arthritis. Degenerative Spondylolisthesis usually occurs at the L4-L5 level of the spine which is the level above where Isthmic Spondylolisthesis usually occurs. The majority of slips are grade one or two and if they start to cause pain they can be treated conservatively without surgery. It seems that once a slip occurs it seldom progresses or worsens. Treatment varies depending on the severity of the condition. Most patients get better with strengthening and stretching exercises combined with activity modification, which involves avoiding hyperextension of the back and contact sports. Patients with a grade two or higher slippage can worsen over time. Patients with these higher grade slips may have a swayback (hyperlordosis), and they often have very tight hamstring muscles. If the hamstring muscles get too tight it can cause a change in walking gait which may look like the patient is waddling. Most people with Spondylolisthesis will never have symptoms and only a small number of those will ever need surgery. A small number of adolescents may need surgical care because their back pain does not respond to conservative treatments. If an adolescent with back pain is found to have Spondylolisthesis it often just requires time away from sports, combined with good conservative care, and the pain should resolve quickly. In most cases, activities can be resumed gradually without complications or recurrences.
Isthmic Spondylolisthesis in AdultsIsthmic Spondylolisthesis can become symptomatic in people in their thirties and forties. If your spinal discs start to wear out, more stress is put on the pars interarticularis and possibly the nerve root, which can cause back and leg pain.To Your Best Health, Dr. Cliff
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