Spondylolysis and spondylolisthesis are caused by “fracturing” of a portion of a vertebra. Cartilage plates in different bones in the body allow for growth while we are young. As we mature, these cartilage plates fuse to form the bones we have as adults. Spondylolysis is a cartilage plate that does not fuse in the lamina of a vertebra. Spondylolisthesis occurs when a spondylolysis is unstable and allows movement between the unfused plates.
Degenerative spondylolisthesis occurs in older individuals secondary to the degeneration of the facet joints in the setting of disc space narrowing Degeneration allows for forward and backward movement of the vertebral body.
The developmental form of spondylolysis/spondylolisthesis occurs in males under the age of 20. Degenerative spondylolisthesis occurs in females over the age of 40.
What are the Symptoms of Spondylolysis/Spondylolisthesis?
In younger years, spondylolysis/spondylolisthesis are frequently unassociated with pain. In many individuals pain while bending forward increases pain. Leg pain may also occur in individuals who have developed scar tissues around the defect that contacts the exiting nerve root (sciatica)
How is Spondylolysis /Spondylolisthesis Diagnosed?
The diagnosis of spondylolysis/spondylolisthesis is confirmed by the discovery of the “fracturing” of the lamina on the lateral x-ray of the lumbar spine. The lesions may also be seen on the anteroposterior view. Spondylolisthesis is identified with movement of the spine with flexion and extension views of the lumbar spine.
How is Spondylolysis/Spondylolisthesis Treated?
Non-surgical therapy can be effective in limiting back pain. Exercises to strengthen the core, with components of flexion strengthening can be useful. Extension exercises are less useful. Corsets or braces can be helpful in decreasing symptoms. This is one of the few times when a brace can be helpful. Bracing may be particularly helpful for individuals with a positive bone scan in the area of the defect. Decreasing movement with a brace has the possibility of reversing the defect.
Surgery in the form of a fusion of the unstable segment is indicated to relieve pain but not to prevent slippage. This is also indicated for individuals with leg pain in association with back pain. A decompression of the compressed nerve in addition to a fusion is necessary to control both back and leg pain.
Refrence: Borenstein DG, Wiesel SW, Boden SD: Low Back and Neck Pain: Comprehensive Diagnosis and Management 3rd ed. W.B. Saunders Philadelphia 2004 pp288