Embedded Files
Spondylolysis/Spondylolisthesis
Description
Your lower back is called your lumbar spine. It is made up of five bones called lumbar vertebrae. The vertebrae have two major parts, a solid segment called the body and a bony "ring" through which the lower part of the spinal cord and nerves travel. Between the bodies of the vertebrae is shock absorbing material called disks. Part of the "ring" of each vertebra, called pars, touches the vertebra above and below it.
Spondylolysis is a condition where there is a break in one or both sides of the ring of a vertebra. Spondylolisthesis is a condition in which a break in both sides of the "ring" allows the body of the vertebra to slip forward.
Examination
Spondylolysis and Spondylolisthesis most commonly occur at the fourth or fifth lumbar vertebrae. These conditions are also called pars defects, pars stress fractures, or stress fractures.
Cause
Spondylolysis and Spondylolisthesis result from repetitive extension of the back (bending backward). This cause weakness in the rings of the lumbar vertebrae, eventually leading to a break (fracture)
in a ring. Less commonly, these conditions may result from an injury to the back. Some experts feel that certain people are born with weak vertebral rings and thus prone to these injuries. Athletes most commonly troubled by spondylolysis or spondylolisthesis are gymnasts, dancers, cheerleaders, and football players.
It is important to report any signs of back pain to your Athletic Trainer. After getting a detailed health history and a history of your back pain, and examination of your back will be performed, looking for tenderness along your vertebrae or spasm in the muscles next to your vertebrae. A spondylolysis test (extension in one-leg standing) will be performed. If positive, you will be referred to a specialist who will order X-rays, which will show a break in the ring of a vertebra (Scotty Dog sign because it resembles a Scottish terrier, fracture appears at "collar" area ) or slippage of a vertebra.
You may experience low back pain or spasms, or you may have no symptoms at all. You may have pain all the time or only during certain activities. This condition usually does not damage the nerves. Pain tends to be more severe than standard "low back pain" and tends to last for longer periods of time (>2-3 weeks).
Treatment
For short term pain relief, your physician may prescribe anti-inflammatory medicine or muscle relaxers. A course of therapy, including exercises and pain modalities may also work. Most often these types of injuries are treated by wearing a rigid "clam shell" brace for 1 to 3 months. Severe cases of spondylolisthesis may require surgery.
Prevention
You can best prevent these conditions by having strong back and abdominal muscles, and minimizing the repetitive stresses that cause these injuries. Early specialization in certain sports, or competing in one sport year round will increase your chances of injury. If you have been diagnosed with spondylolysis you may be able to prevent progression to spondylolisthesis by doing back exercises and avoiding forced back extension activities.
Recovery/Rehabilitation
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at different rates. Return to your sport will be determined by how soon your back recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better.
It is important that you have coordinated care with your Athletic Trainer or Therapist and fully recovered from you low back pain before you return to your sport. You must have the same pain-free range of motion as before the injury, and full strength. You must be able to run, jump and twist without pain.
Page updated
Report abuse