Spondylolysis and Spondylolisthesis

Anatomy

Your spine is made up of 24 small rectangular-shaped bones called vertebrae stacked on top of each other. These bones connect to form a canal that protects the spinal cord.

The five vertebrae in the lower back make up the lumbar spine.

Other parts of your spine include:

• Spinal Cord and Nerves: These “electrical wires” run through the spinal canal, carrying messages between your brain and muscles. Nerve roots emerge from the spinal cord through openings in the vertebrae.
  Facet Joints: Between and behind adjacent vertebrae are small joints that provide stability and help control the movement of the spine. Facet joints work like hinges and run in pairs along the length of the spine on either side.
  Intervertebral Discs: There are flexible intervertebral discs between the vertebrae. These discs are flat and round and about half an inch thick. Intervertebral discs cushion the vertebrae and act as shock absorbers when walking or running.

Spondylolysis and spondylolisthesis are different spinal conditions, but they are often related to each other.

What is Spondylolysis?

In spondylolysis, a crack or stress fracture develops along the pars interarticularis (pars fracture). The pars interarticularis is a small, thin portion of the vertebra that connects the upper and lower facet joints.

This fracture most commonly occurs in the fifth vertebra of the lumbar spine, but sometimes also occurs in the fourth lumbar vertebra. The fracture can occur on one or both sides of the bone.

The pars interarticularis is the weakest part of the vertebra. As such, it is the area most vulnerable to injury from the repetitive stress and overuse that characterizes many sports. Spondylolysis can occur in people of any age without injury or sports participation. Often, patients with spondylolysis will also have some degree of spondylolisthesis.

What is Spondylolisthesis?

In spondylolisthesis, the fractured pars interarticularis separates, allowing the injured vertebra to slide forward or slide forward on the vertebra directly below it. In children and adolescents, this shift occurs most during periods of rapid growth (for example, during puberty).

Doctors often describe spondylolisthesis as low-grade or high-grade, depending on the amount of slippage. High-grade slip occurs when more than 50% of the width of the fractured vertebra slides forward on the vertebra below it. Patients with high-grade dislocations are more likely to experience severe pain and nerve injury and need surgery to relieve their symptoms and prevent further worsening.

Etiology

Overuse

Both spondylolysis and spondylolisthesis are more likely to occur in young people who participate in sports that require frequent overstrain (hyperextension) of the lumbar spine, such as gymnastics, soccer, and weightlifting. Over time, such repetitive activity can weaken the pars interarticularis and cause the vertebrae to fracture and/or slip.

Genetic

The lower lumbar spine is at risk of developing stress weakness at the site of spondylolysis in all children, adolescents and adults who walk upright. Doctors believe that some people are born with a thinner-than-normal vertebra, which can make them more vulnerable to fractures.

What are the symptoms?

In most cases, patients with spondylolysis and spondylolisthesis do not have any obvious symptoms. The conditions may not be discovered until an X-ray is taken for an unrelated injury or condition.

When symptoms do occur, the most common symptom is lower back pain. This pain:

• It is similar to a muscle strain.
• It spreads to the buttocks and back of the thighs.
• It worsens with activity and improves with rest.

Muscle spasms in patients with spondylolisthesis can lead to additional signs and symptoms, including:

• Back stiffness
• Stiffness in the muscles of the back of the thigh (hamstrings)
• Difficulty standing and walking

Spondylolisthesis patients with severe or high-grade dislocation may have tingling, numbness, or weakness in one or both legs. These symptoms result from pressure on the spinal nerve root as it exits the spinal canal near the fracture. Pain from spondylolysis and spondylolisthesis begins in the middle of the lower back and radiates downward.

Computed Tomography (CT) scans can be helpful in learning more about the fracture or slippage and in planning treatment.

Magnetic Resonance Imaging (MRI) scans can help determine if there is early degeneration of the intervertebral discs between the vertebrae or if a slipped vertebra is pressing on the spinal nerve roots.

Treatment

The goals of spondylolysis and spondylolisthesis treatment are:

• Reducing pain
• Healing of a new pars fracture
• Returning to sports and other daily activities

Spondiloliz ve Spondilolistezisin Ameliyatsız Tedavisi

For most patients with spondylolysis and low-grade spondylolisthesis, back pain and other symptoms will improve with nonsurgical treatment.

Nonsurgical treatment may include:

• Rest: Avoiding sports and other activities that put excessive pressure on the lower back for a period of time can often help improve back pain and other symptoms.
• Non-steroidal anti-inflammatory drugs: Medications such as ibuprofen and naproxen can help reduce swelling and relieve back pain.
• Physical Therapy: Specific exercises can help improve flexibility, stretch tight hamstrings, and strengthen muscles in the back and abdomen.
• Support: Some patients may have to wear a back brace for a while to limit movement in the spine and allow a new pars fracture to heal. Although athletes with sudden or acute onset of pain are candidates for brace therapy, patients with longer-term pain are not suitable. The chances of recovery of a stress fracture in these patients will be low even after months of wearing a brace.

Surgical Treatment of Spondylolysis and Spondylolisthesis

Surgery may be recommended for patients with spondylolisthesis who have:

• Severe or high degree of slippage
• Worsening slippage
• Back pain that does not improve after a period of non-surgical treatment

Spinal fusion between the fifth lumbar vertebra and the sacrum is the most commonly used surgical procedure in the treatment of patients with spondylolisthesis.

The goals of spinal fusion are:

• Prevent further slippage
• Stabilizing the spine
• Relieve back pain

Surgical Procedure

Spinal fusion is actually a welding process. Its basis is to fuse the affected vertebrae into one solid bone. Fusion removes movement between damaged vertebrae and takes some of the spine’s flexibility. The theory is that if the painful spinal segment doesn’t move, it shouldn’t hurt.

During the procedure, the vertebrae in the lumbar spine are realigned first. Small pieces of bone, called bone grafts, are then inserted into the spaces between the vertebrae to be fused. Over time, the bones grow together, similar to the healing of a broken bone.

Before placing the bone graft, metal screws and rods may be used to further stabilize the spine and increase the chances of successful fusion.

In some cases, patients with high-grade slip will also have compression on the spinal nerve roots. In this case, he may perform a procedure to open the spinal canal and relieve pressure on the nerves before performing the spinal fusion.

Results

The majority of patients with spondylolysis and spondylolisthesis are relieved of pain and other symptoms, sometimes within a few weeks or months. In most cases, the patient can gradually resume sports and other activities with few complications or relapses.

He may be advised to do specific exercises to stretch and strengthen the back and abdominal muscles to help prevent future injuries. In addition, you will need regular check-ups for complication follow-up.