Spondylolisthesis

Definition

Spondylolisthesis is a condition in which a bone (vertebra) in the lower part of the spine slips forward and onto a bone below it.

Causes

In children, spondylolisthesis usually occurs between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum area. It is often due to a birth defect in that area of the spine.

In adults, the most common cause is degenerative disease (such as arthritis). The slip usually occurs between the fourth and fifth lumbar vertebrae.

Other causes of spondylolisthesis include stress fractures (commonly seen in gymnasts) and traumatic fractures. Spondylolisthesis may occasionally be associated with bone diseases.

Spondylolisthesis may vary from mild to severe. It can produce increased lordosis (swayback), but in later stages may result in kyphosis

Symptoms may include lower back pain and pain in the thighs and buttocks, stiffness, muscle tightness, and tenderness in the slipped area. Neurological damage (leg weakness or changes in sensation) may result from pressure on nerve roots and may cause pain radiating down the legs.

Symptoms

• Lordosis
• Lower back pain
• Localized tenderness over the spine just above the pelvis
• Pain in thighs
• Pain in buttocks
• Tight hamstrings
• Stiffness in back

Exams and Tests

• X-ray of the spine (demonstrates misalignment of lumbar vertebra, and possible fracture)
• A straight leg raise may be uncomfortable or painful

NOTE: A person with spondylolisthesis may have no symptoms.

Treatment

Treatment varies depending on the severity of the spondylolisthesis. Most patients require only strengthening and stretching exercises combined with activity modification (avoiding hyperextension of the back and contact sports). Some practitioners also use a rigid brace.

For cases with severe pain not responding to therapy, if the slip is severe, or there are neurologic changes, the slipping vertebra might be surgically fused. This surgery has a higher incidence of nerve injury than most other spinal fusion surgeries. A brace or body cast may be used after surgery.

Outlook (Prognosis)

Conservative therapy for mild spondylolisthesis is successful in about 80% of cases. When necessary, surgery produces satisfactory results in 85 - 90% of people with severe, painful spondylolisthesis.

Possible Complications

• Nerve compression
• Temporary or permanent damage of spinal nerve roots, which may cause sensation changes, weakness, or paralysis of the legs
• Chronic back pain

When to Contact a Medical Professional

Call your health care provider if your child's back appears to curve excessively, if the child complains of back pain or stiffness, or pain in the thighs and buttocks.

Prevention

People with marked lordosis should avoid back hyperextension (leaning way back), weight lifting, and contact sports. Lower back pain, although common in preadolescent and adolescent children, should be evaluated -- especially in the presence of marked lordosis.