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Spondylolysis and Spondylolisthesis
Spondylolysis and spondylolisthesis are the most common causes of low back pain in adolescent athletes.
- Spondylolysis (spon-dee-low-lye-sis): A stress fracture in the posterior spine pars that are part of the spine. This is the weakest part of the spine, especially in younger patients whose bones are still maturing.
- Spondylolisthesis (spon-dee-low-lis-thee-sis): The vertebra can start to shift out of place if a stress fracture weakens the bone so much that it is unable to maintain its proper position.
Causes and Risk Factors
Some children are born with a predisposition to develop spondylolysis or spondylolisthesis. In others, it is caused by overuse. Some sports, like gymnastics, weight lifting and football, put a great deal of stress on the bones in the lower back. Spondylolisthesis can cause spasms that stiffen the back and tighten the hamstring muscles, resulting in changes to posture and gait.
Symptoms and Types
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. The pain often gets worse with activity and is more noticeable when bending backward.
Diagnosis and Tests
X-rays of the lower back, an MRI or a CT scan may be used for diagnosis.
Treatment and Care
- Nonsurgical Treatment: Take a break from the activities until symptoms go away. Activities can be resumed gradually and with few complications or recurrences. Some patients may need up to 6 months to become pain free with activities and rehabilitation exercises before they transition back into sports. Anti-inflammatory medications, such as ibuprofen, may help reduce back pain. Sometimes, a back brace and physical therapy may be recommended. Stretching and strengthening exercises for the back and abdominal muscles can help prevent future recurrences of pain.
- Surgical Treatment: Surgery may be needed if slippage progressively worsens and does not respond to non-surgical treatment. A spinal fusion may be recommended.
Living and Managing
Children can attend school and participate in activities without limitation once symptoms go away. Anti-inflammatory medications, stretching regularly and strengthening exercises can help manage occasional pain.