Spondylolysis / Spondylolisthesis

​Overview

Spondylolysis is a stress fracture in one of the bones (vertebrae) that make up the spinal column. The condition usually affects the fifth lumbar vertebra in the lower back and, much less commonly, the fourth lumbar vertebra. If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to shift out of place. This condition, called spondylolisthesis may require surgery if too much slippage occurs and the bones press on the spinal nerves.

Symptoms

The symptoms of spondylolysis depend on the location of the injury. They range from mild to severe and may become chronic or disabling, depending on severity. Symptoms of spondylolysis affecting the cervical spine, or neck may cause:
  • Pain that comes and goes
  • Pain that spreads into your shoulders, arms, hands, or fingers
  • Morning neck or shoulder stiffness or a limited range of motion after getting out of bed
  • Neck or shoulder tenderness or numbness
  • Weakness or tingling in your neck, shoulders, arms, hands, or fingers
  • Headache in the back of your head
  • Loss of balance
  • Difficulty swallowing (This is rare, but it may occur if the spinal cord is compressed.)
Symptoms of spondylolysis affecting the thoracic spine (mid-back) may include:
  • Pain in the upper and mid sections of the back
  • Bending and extending your body triggers pain
  • Morning mid-back stiffness after getting out of bed
Symptoms of spondylolysis affecting the lumbar spine, or lower back may include:
  • Pain that comes and goes
  • Morning low back stiffness after getting out of bed
  • Pain that decreases with rest or after exercise
  • Low back tenderness or numbness
  • Sciatica (mild to intense leg pain)
  • Weakness, numbness, or tingling in the low back, legs, or feet
  • Difficulty walking
  • Bowel or bladder problems (This is rare, but it may occur if the spinal cord is compressed.)

Causes

Genetics
There may be a hereditary aspect to spondylolysis. An individual may be born with thin vertebral bone and therefore may be vulnerable to this condition. Significant periods of rapid growth may encourage slippage.

Overuse
Some sports, such as gymnastics, weight lifting, and football, put a great deal of stress on the bones in the lower back. They also require that the athlete constantly overstretch (hyperextend) the spine. In either case, the result is a stress fracture on one or both sides of the vertebra.
  • In many people, spondylolysis and spondylolisthesis are present, but without any obvious symptoms.
  • Pain usually spreads across the lower back and may feel like a muscle strain.
  • Spondylolisthesis can cause spasms that stiffen the back and tighten the hamstring muscles, resulting in changes to posture and gait. If the slippage is significant, it may begin to compress the nerves and narrow the spinal canal.

Diagnosis

X-rays of the lower back (lumbar) spine will show the position of the vertebra. The pars interarticularis is a portion of the lumbar spine. It joins together the upper and lower joints. The pars is normal in the vast majority of children.
  • If the pars "cracks" or fractures, the condition is called spondylolysis. The X-ray confirms the bony abnormality.
  • If the fracture gap at the pars widens and the vertebra shifts forward, then the condition is called spondylolisthesis. Usually, the fifth lumbar vertebra shifts forward on the part of the pelvic bone called the sacrum. The doctor measures standing lateral spine X-rays. This determines the amount of forward slippage.
  • If the vertebra is pressing on nerves, a CT scan or MRI may be needed before treatment begins to further assess the abnormality.

Complications

  • Aging and wear and tear on your spine are the major risk factors for cervical spondylosis.
  • You may be more likely to develop cervical spondylosis if you've had a neck injury.
  • Spondylosis is also the most common cause of low back pain in adolescent athletes.
  • Cervical spondylosis is more common in people who have had neck injuries.
  • Such trauma might include work and recreational-related stress.

Risk Factors

Certain congenit​al, genetic and acquired risk factors for cervical spondylosis have been identified by researchers:
  • The condition may run in families.
  • A congenitally narrow spinal canal increases the risk of developing cervical spondylosis with myelopathy. With a narrow spinal canal, the spinal cord -- a very sensitive structure that relays feelings to the brain and movement commands from the brain to the muscles -- has less space to fit inside the column of bone it occupies. Spinal canals also narrow as a result of the age-related changes of thickening of spinal ligaments and bone. This type of narrowing has the same effect as congenital narrowing.
  • Several varieties of excessive segmental motion such as atlantotaxial instability, often present in persons with Down syndrome, cerebral palsy and rheumatoid arthritis, are known risk factors.
  • Smoking contributes to degenerative disk disease, and is therefore a risk factor.
  • History of trauma (hits and blows) to the forehead predispose one to cervical spondylosis.

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