Spondylolysis (spon-dee-low-listh-esis) = a weak spot in the back portion of one of the lower vertebrae in the back. Spondylolisthesis = the weakened vertebra slides forward a bit on the spine below. It usually affects either the fourth or the fifth lumbar vertebra in the lower back. If too much slippage occurs, the bones may begin to press on nerves and surgery may be necessary to correct the condition.
Genetics: There may be a hereditary aspect to spondylolysis. An individual may be born with thin vertebral bone and therefore 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 over-stretch (hyperextend) the spine. In either case, the result is a stress fracture on one or both sides of the vertebra. Spondylolisthesis may also develop because of degenerative changes in the vertebral joints and certain medical conditions such as cerebral palsy.
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.
X-rays of the lower back (lumbar) spine will show the position of the vertebra. Usually, spondylolisthesis occurs in the last lumbar vertebra, just above the tailbone (sacrum). If the vertebra is pressing on nerves, a CT scan or MRI may be needed before treatment begins to rule out any other contributing conditions.
Initial treatment for spondylolysis is always conservative. The athlete should take a break from the activities until symptoms go away, as they often do. Anti-inflammatory medications such as ibuprofen may help reduce back pain. Occasionally, a back brace and physical therapy may be recommended. Epidural steroid injections may also help alleviate inflammation and ease pain. In most cases, activities can be resumed gradually and there will be few complications or recurrence. Stretching and strengthening exercises for the back and abdominal muscles can help prevent future stress fractures.
Periodic X-rays will show whether the bone is continuing to slip. Surgery may be need if slippage continues, or if the back pain does not respond to conservative treatment and begins to interfere with activities of daily living. This is more often the case with degenerative spondylolisthesis.
Usually, two procedures are performed, one to relieve the nerve compression and the second to ensure spinal stability. The first procedure, called a decompressive laminectomy, removes part of the bone that is pressing on the nerves. This reduces irritation and inflammation, but increases the instability of the spine. Hence the need for the second procedure, called spinal fusion.
In spinal fusion, a piece of bone is transplanted to the back of the spine. As the bone heals, it fuses with the spine and helps to stabilize it. Sometimes, an internal brace of screws and rods is used to hold the vertebra together as the fusion heals. Please talk to Dr.Rao for further details of how this may help you.