Lower back pain is a very common complaint, and as an orthopedic spine surgeon, many patients come to me for answers about the cause of their back pain and how to alleviate it.
Two conditions I often see accompanied by back pain – especially with athletes who play sports involving a high level of stress on the lower back – are spondylolysis and spondylolisthesis.
These conditions are not the same, but they are related. Spondylolysis is a crack or stress fracture in a vertebra, often the fifth vertebra of the lumbar (lower) spine. Cracks can be present on one side or both sides of the bone. In some cases, the crack weakens the bone to the extent that it leads to spondylolisthesis, which involves the vertebra slipping or shifting out of place.
Many people with spondylolysis or spondylolisthesis can recover with rest, anti-inflammatory medications, and exercises that strengthen the core. A small percentage of patients may need surgery if their pain cannot be relieved by more conservative methods. But, in most cases, these conditions are considered treatable.
Causes of Spondylolysis and Spondylolisthesis
In spondylolysis, the fracture develops through the pars interarticularis. This is a small, thin portion of the vertebra that connects the upper and lower facet joints, which provide stability and help control the movement of the spine. It is the weakest portion of the vertebra and is highly vulnerable to injury from the repetitive stress that is common in sports such as gymnastics, football, and weightlifting.
If untreated, spondylolysis can weaken the injured vertebra so much that it slips or shifts forward onto the vertebra directly below it. This results in the condition known as spondylolisthesis, when the vertebra can no longer maintain its proper position in the spine.
These conditions can affect people of all ages, and sometimes genetics can be a contributor, but children and adolescents who participate in sports that involve “twisting” or repeated stress to the lower back are often more susceptible.
Symptoms and Diagnosis
In many cases, people with spondylolysis or spondylolisthesis don’t even realize they have the condition. When symptoms do occur, lower back pain is most common. Pain from spondylolysis may feel like a muscle strain that spreads across the back and radiates downward, often getting worse with physical activity.
In patients who have spondylolisthesis, additional symptoms may include muscle spasms, back stiffness, tight hamstrings, or difficulty walking and standing.
Along with an orthopedic doctor’s examination and complete medical history, X-rays of the lower back will help confirm a diagnosis by identifying cracks and evaluating the position of the vertebra. A CT or MRI scan might be needed to detect tiny fractures or show more detail.
Initial treatment recommendations are conservative (nonsurgical), starting with a period of rest and a break from sports and high-impact activities. Anti-inflammatories such as ibuprofen and naproxen can help with back pain and swelling. For many of my patients, I prescribe exercise or physical therapy to improve flexibility and strengthen back and abdominal muscles. Sometimes I prescribe a brace to help stabilize the lower back and facilitate healing.
If lower back pain does not improve or there is severe or worsening slippage, spine surgery may be recommended – most often lumbar spinal fusion, a common procedure that involves fusing the injured vertebrae together so they essentially become a single bone. This helps prevent further slippage and adds stability to the spine, with the goal of avoiding excessive movement and alleviating persistent back pain.
In the following video, I explain more about lumbar spinal fusion:
The good news is that many people with spondylolysis or spondylolisthesis can gradually return to sports and normal activities after treatment, with few complications and recurrences. For more from a patient who’s had lumbar spinal fusion for spondylolisthesis with stenosis, watch Dee’s story:
About the Author:
Theodore Koreckij, M.D. is a board-certified and fellowship-trained orthopedic surgeon specializing in conditions of the spine, including adult degenerative disorders and conditions associated with metastatic disease.
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