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Understanding Radiology Of Spondylolysis/Spondylolisthesis

Lower back pain, especially when felt by young athletes, can be a symptom of a more serious issue. Spondylolysis and spondylolisthesis are two conditions that cause lower back pain in young athletes. These are two fancy terms for a stress fracture or crack in one of the vertebrae, which are the small bones that comprise the entire spinal column.

What are Spondylolysis and Spondylolisthesis?

This injury happens most often in adolescents and children that frequently participate in sports that put repeated pressure or stress on the lower back region. These sports would include things like weightlifting, gymnastics, and football.

There are some cases of this condition where the stress fracture ends up weakening the bone to the point where it is no longer able to retain its natural position within the spine. When this happens, the vertebra will begin to slip out of place and shift, causing the much more serious condition of spondylolisthesis.

Spondylolysis and Spondylolisthesis Treatments

Those that have had either of these conditions may find that their back pain and other major symptoms can be improved and relieved after certain types of treatment. However, this series of treatments must always begin with rest from the strenuous activities or athletics of any kind.

Any patient that has a persistent and excruciating back pain might also have vertebrae slippage. They might end up needing surgery to relieve the symptoms before they can ever start back with their activities or their desired sports.

Understanding the Condition: Spondylolysis

First, we will look at spondylolysis. This is a condition with a stress fracture or crack of the spine that develops through the portion of the vertebra called the pars interarticularis. This area connects the lower and upper facet joints. It is commonly found in the fifth vertebra within the lumbar spine or the lower spine. However, it has been seen in the fourth lumbar vertebra as well. It doesn’t matter which side of the bone it happens either since it can occur on either side.

Since the pars interarticularis is known as the weakest part of the vertebra, it is no wonder that stress fractures and cracks are so common here. This is also why it is the most vulnerable area to the overuse or repetitive stress seen during many sports and activities. There is no age limit to the condition, though it most often happens in adolescents and children due to their still growing spine.

Understanding the Condition: Spondylolisthesis

Spondylolisthesis is most often caused by patients never getting treatment for spondylolysis. It occurs when the vertebra is no longer able to maintain the proper and natural position within the spine, causing a slip. The fractured area of the pars interarticularis in spondylolisthesis will separate, which initially sets the stage for that painful slip. The slippage in adolescents and children will most often occur during the times of rapid growth, like an adolescent growth spurt.

There are high grade and lower grade diagnosis to these conditions, which will depend largely on the amount of slippage that has. High-grade slippage is diagnosed when more than 50-percent of the fractured vertebra are forced forward onto the vertebra right below it. Any patient with a high-grade slippage is more at risk for nerve damage and extreme pain in the region. High-grade slippage must be repaired through surgery.

Causes of Spondylolysis and Spondylolisthesis

Doctors believe that there are several causes for these two spinal conditions. First, they are most likely to occur in younger people who tend to participate in high-activity sports that require extensive stretching, like weightlifting, football, or gymnastics. This major overuse can be found in even adults, but it is most common in children and adolescent individuals that participate in these sports. The overuse will weaken the area of the pars interarticularis, which causes the fracture or eventually slippage of the spinal vertebra.

Some experts have suggested that genetics can play a role in the causes of this condition. For example, some believe that people are born with thinner vertebral bones that make them more vulnerable to the fractures that cause pain and other issues.

Radiology and Examinations

Before these conditions can be diagnosed, a physician must perform a series of tests to determine the source of the back pain, since back pain can have many different causes.

First, your doctor will get your medical history as well as asking about your general health. The symptoms will also be addressed and considered in the diagnosis. Next, your doctor will consider the participation in sports, no matter how old the patient may be. If the patient participates in the sport with an excessive strain in the lower back region, the doctor will be more likely to consider spondylolisthesis as a possible cause.

Next, the doctor will examine the patient for things like muscle spasms, tender areas, the range of motion limitations, and muscle weakness. The posture of the patient as well as the way they walk will be considered as well.

If the doctor thinks that this condition might be the culprit of the back pain, they will begin with a series of imaging tests to confirm the diagnosis. First, an x-ray will be done to look at the bones. The x-ray will be done on the lower back region from various angles to look for cracks or stress fractures. The alignment of the various vertebrae will also be looked at through the x-ray.

Should the x-ray show a stress fracture within the pars interarticularis area or the fourth and fifth lumbar vertebra, the diagnosis will be complete. Doctors might also order various other tests like CT scans (computerized tomography) to look at the slippage or fracture with a deeper perspective, or they might order an MRI scan(magnetic resonance imaging) to look at the soft tissues of the back and check for damage between the vertebrae or spinal nerve roots.

Solutions

In most cases treatment for early stage Spondylolysis can be achieved with simple rest, bracing, and physical therapy to help improve the flexibility and strength in the back. However, there are some cases where surgery might be required to fix the issue, but this is most common with spondylolisthesis patients with high-grade slippage, a slippage that is getting worse, or those with no improvement in their back pain after nonsurgical treatments.

Back pain is a common issue among many people in the world, especially those that participate in sports or are younger. Spondylolysis and spondylolisthesis are related conditions that can cause severe back pain, as well as a host of other issues. Those that have back pain and participate in sports that put strain on the lower back region should talk with their doctor about possible prevention and solutions.

One major solution is physical therapy to help put strength and flexibility into the lower back region. Visit us at Dynamic Physiotherapy to get the treatment you need to get back to your daily activities without back pain. We make it our mission to help you get through the difficult times and recover from injury to all parts of the body. We want to ensure that you get well soon.

To book an appointment, call Dynamic Physiotherapy today at 289-201-2451 or contact us here.


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