Spondylolysis and Spondylolisthesis

Spondylolysis and Spondylolisthesis

Spondylolysis is a defect in the spine at a part of the bone known as the pars interarticularis. This pars region connects the front part of the back bone (vertebral body), which houses the spinal cord and nerves, to the back part of the back bone (posterior elements).

Spondylolisthesis is commonly associated with spondylolysis. Spondylolisthesis typically occurs when someone has a spondylolysis and then as a result, one bone slips forward in relation to another.

These two conditions are the most common causes of chronic back pain in children.

Diagnosis

At your appointment, your child’s doctor will look for signs of stress fractures by:

  • Taking a complete medical history.
  • Doing a physical examination.
  • Getting an X-ray of the lower back.

Sometimes a computed tomography (CT) scan or a magnetic resonance imaging (MRI) might be used to look for very small fractures, to rule out other possible causes of pain, and to plan treatment options.

Possible causes

Spondylolysis is caused by genetics, overuse or repeated injuries, or a combination of the three. Children at highest risk to develop these defects are those who join in sports that require children to repeatedly arch their backs. Those sports include gymnastics, cheerleading, weightlifting and football.

Many children are symptom-free and the condition is often overlooked. However, when spondylolysis has symptoms, it is typically lower back pain, which is made worse because of arching the back. In rare cases, your child could feel pain that goes down the legs. The pain is typically severe enough that your child may not want to join in a sport.

Treat

A moderate approach will often work to treat spondylolysis.  

  • Rest
  • Medication
  • Physical therapy

Treatment is intended to reduce pain and swelling, which usually allows the fracture to heal. In some cases, a back brace may be worn for a short time to take the pressure off the lower back.

If your child’s pain continues, he or she may need surgery. We typically perform two types of surgeries:

  • Fracture repair: In this procedure, the goal is to repair the bone by bridging a metal implant and a bone graft across the fracture.
  • Lumbar fusion: In this procedure, the goal is to fuse the bone together using screws and a bar to stabilize the spine. A bone graft is also used to help the bones grow back together.