Spondylolisthesis and Spondylolysis

Overview

Spondylolisthesis and Spondylolysis are two separate conditions that tend to occur together. Spondylolisthesis occurs when that stress fracture causes the pars interarticularis to separate, allowing the damaged vertebrae to shift or slip forward. Spondylolysis is a stress fracture develops in the section of the vertebra that connects the upper and lower facet joints (pars interarticularis). These conditions are most commonly found in children and adolescence and can be cured both surgically and non-surgically. Most cases are treated non-surgically first. Surgical treatments are not attempted until the spondylolisthesis is severe or nonsurgical treatments were ineffective. The most common surgical treatment is spinal fusion, a procedure involving the joining of damaged vertebrae. Most patients are free from pain after either treatment and have a complete recovery.

ANATOMY

The spine consists of 33 individual bones (vertebrae) that interlock. The vertebrae are categorized into five regions:

• Cervical
• Thoracic
• Lumbar
• Sacrum
• Coccyx

The spine is also home to the intervertebral disc, spinal cord, nerves, and facet joints.
Intervertebral discs are flat, round, flexible discs located between the vertebrae.Their purpose is to cushion the vertebrae and act as shock absorbers during movement.

Spinal cord and nerves are like wires that travel through the spine carrying messages between the brain and muscles. Nerve roots branch out from the spinal cord through openings in the vertebrae.

Facet joints are located between the back of the vertebrae. They are small joints that help control spinal movement while providing stability.

DESCRIPTION

Spondylolysis and spondylolisthesis are two separate conditions that are commonly seen together. Spondylolysis is a crack or stress fracture in the small, thin part of the vertebra that connects the upper and lower facet joints in the lumbar spine (pars interarticularis). The pars interarticularis is most vulnerable to injury as it is the weakest part of the vertebra. This condition frequently happens in children because their spines are still developing, meaning that the pars interarticularis is even more vulnerable than in adults. In most cases, patients with spondylolysis will also have some degree of spondylolisthesis.

Spondylolisthesis occurs when spondylolysis has weakened the vertebrae so much that it cannot maintain its proper position in the spine. This happens because the pars interarticularis will actually separate, allowing the damaged vertebrae to shift or slip forward on the vertebrae directly below it. Spondylolisthesis can be categorized as either low grade or high grade, depending on how much the vertebrae has slipped. Both overuse and genetics can cause spondylolysis and spondylolisthesis.

SYMPTOMS

Many cases of spondylolysis and spondylolisthesis do not have any clear symptoms. Often times, these conditions will not even be discovered until an x-ray is taken. If symptoms do occur, they will include lower back pain that may:

• Worsen with activity but improve with rest.
• Have a similar feeling to muscle strains.
• Radiate to the buttocks and back of thighs.

Additionally, patients with spondylolisthesis may experience muscle spasms that lead to additional signs and symptoms such as:

• Tight hamstrings (muscles behind the thigh).
• Difficulty standing and walking.
• Back stiffness.
• Tingling, numbness, and weakness in one or both of the legs.

DIAGNOSIS

Your Florida Orthopaedic Institute physician will analyze your medical history, general health, and symptoms. After your physician will carefully examine your back and spine, keeping an eye out for areas of tenderness, limited range of motion and muscle spasms and weakness. Additionally, imagining tests may be performed to help confirm the diagnosis. These tests include:

• X-rays. This test provides images of dense structures such as bone and will show a stress fracture as well as the amount of forward slippage.
• CT scans. Computerized tomography (CT) scans are more detailed than x-rays and will show more of the fracture and slippage.
• MRI scans. Magnetic resonance imaging (MRI) scans provide images of the soft tissues within the body, which can help determine if there is any damage to the intervertebral discs or if the spinal nerve roots are being compressed by a slipped vertebra.

TREATMENT (OVERVIEW)

There are both surgical and nonsurgical treatment options available for spondylolysis and spondylolisthesis. In most cases, nonsurgical treatment options are tried first before any surgical treatments are considered. If the spondylolisthesis is high-grade or if nonsurgical treatments have been exhausted and with no improvements to symptoms, then surgery is considered.

NON-SURGICAL TREATMENTS

Most patients with spondylolysis and low-grade spondylolisthesis benefit greatly from nonsurgical treatments. During these treatments, your physician takes periodic x-rays to determine whether the vertebra is changing position. Possible nonsurgical treatment options include:

• Medication. Nonsteroidal anti-inflammatories such as ibuprofen (Advil, Motrin) and naproxen (Aleve) can help reduce back pain and swelling.
• Rest. Avoiding activities that place excessive stress on the lower back such as sports can help ease back pain as well as other symptoms.
• Bracing. Braces can be used to limit spinal movement while providing an opportunity for the stress fracture to heal.
• Physical therapy. Certain exercises can help improve flexibility, strengthen muscles in the back and abdomen and stretch tight hamstring muscles.

SURGICAL PROCEDURES/TREATMENTS

Surgical treatments are only recommended for spondylolisthesis that did not respond to nonsurgical treatments and with severe or high-grade slippage or slippage that is progressively worsening. The most common procedure for spondylolisthesis is spinal fusion, a procedure that involves fusing together the affected vertebrae stabilizing the spine, alleviating significant back pain and preventing further progression of the slippage. During the procedure, the vertebrae is realigned and metal screws and rods are used to stabilize the spine further and improve chances of a successful procedure. Bone graft (small pieces of bone) are placed in the spaces between the vertebrae. The vertebrae are then fused together. Over time, the vertebrae heals into one solid bone.

If the slippage has caused the spinal nerve roots to become compressed, another procedure may be performed before the spinal fusion to open up the spinal canal and relieve pressure on the nerves.

NEXT STEPS

The majority of patients with spondylolysis and spondylolisthesis are free from pain and other symptoms after treatment. Recovery from surgical treatment takes approximately three to six weeks and is often paired with physical therapy. In most cases, sports and other activities can be resumed gradually with few complications or recurrences.

Your physician may recommend specific exercises to help prevent future injury. Regular check-ups are necessary to ensure that problems do not develop.