Spondylolithesis is forward slippage of a lumbar (lower back) vertebra on the vertebra below it.
Causes, incidence, and risk factors
The spine is divided into 5 anatomical sections: cervical (neck), thoracic (thorax or rib cage), lumbar (the lower back from bottom of the thoracic spine to the top of pelvis), sacral (pelvis) and coccygeal (tail).
Spondylolisthesis is a condition in which a vertebra slips forward on the vertebra below it. In children this normally occurs between the fifth lumbar vertebra and the first sacral vertebra and is often due to a congenital malformation of that region of the spine.
In adults, the most common cause is degenerative disease (like arthritis) and the slip usually occurs between the fourth and fifth lumbar vertebrae.
Other causes of spondylolisthesis include stress fractures (caused by repetitive hyper-extension of the back, commonly seen in gymnasts), and traumatic fractures. Spondylolisthesis may occasionally be associated with bone diseases.
Spondylolisthesis may vary from mild to severe. It is associated with and can produce increased lordosis (abnormal convexity of the spine or swayback), but in later stages may result in kyphosis (roundback) as the upper spine “falls off” the lower spine.
Symptoms may include lower back pain and pain in the thighs and buttocks, stiffness, muscle tightness, and tenderness in the slipped area. Neurologic damage (leg weakness or changes in sensation) may result from pressure on nerve roots and may cause pain radiating down the legs.
- marked lordosis
- lower back pain
- localized tenderness over the spine just above the pelvis
- pain in thighs
- pain in buttocks
- tight hamstrings
- stiffness in back
Signs 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 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.
Conservative therapy for mild spondylolisthesis is successful in about 80% of cases. When necessary, surgery produces satisfactory results in 85 to 90% of people with severe, painful spondylolisthesis.
- compression and temporary/permanent damage of spinal nerve roots, which may cause sensation changes, weakness, or paralysis of the legs.
- chronic back pain
Calling your health care provider
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.
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.
by David A. Scott, M.D.