Spondylolysis and Spondylolisthesis

What is spondylolysis and spondylolisthesis?

Spondylolysis and spondylolisthesis are two conditions of the spine that can cause pain and discomfort.

Spondylolisthesis is a condition in which there is a defect or stress fracture in the vertebral arch of a vertebra. This defect can cause a misalignment of the vertebrae (spondylolisthesis), resulting in instability in the lower back. The vast majority of spondylolisthesis defects usually occur (85-95%) in the fifth lumbar vertebra (L5) or in the fourth or fifth lumbar vertebra (more in children).

Spondylolisthesis is the displacement of one vertebra over another, either forward (anterolisthesis) or backward (retrolisthesis). This condition can cause pain and instability in the lower back.

Spondylolisthesis is often caused by a fracture of the vertebral arch (spondylolisthesis): approximately 50% to 81% of people with spondylolisthesis develop spondylolisthesis.

Spondylolisthesis is classified/numbered up to 5 grades, based on slippage (Grade I: 0-25%, Grade II: 25-50%, Grade III: 50-75%, Grade IV: 75-100%, and Grade V: greater than 100%).

Both conditions can cause nerve compression, stenosis and/or pain in the lower back and legs.

What are the causes of spondylolysis and spondylolisthesis?

Spondylolysis may be congenital or acquired. The congenital form is caused by a defect in the formation of the spine during fetal development, which is present at birth (often in the fifth lumbar vertebra).

The exact cause of spondylolysis is unknown and spondylolisthesis is acquired. It may be caused by a combination of factors, such as repetitive stress on the low back (e.g. repetitive physical activity in sports involving repetitive flexion and extension movements such as gymnastics, weight lifting…); direct trauma or injury to the spine; or factors such as disc degeneration and/or muscle imbalances.

What are the symptoms of spondylolysis and spondylolisthesis?

The symptoms of spondylolysis and spondylolisthesis vary from person to person, and depending on the severity of the fracture and the area affected.

This condition is present in up to 6% of the population, however, only 10-15% of people will develop symptoms.

Most people experience pain in the back, which may radiate into the buttocks or legs (sometimes with weakness, numbness or tingling), stiffness or muscle spasms. It can also cause instability, difficulty walking or staying in one position for long periods of time, sensory disturbances and/or incontinence.

How are spondylolysis and spondylolisthesis diagnosed?

The diagnosis of spondylolysis or spondylolisthesis can be made by X-rays, but is often supplemented by an MRI or CT scan, as well as a physical examination by the spine specialist. These tests can show the fracture in the vertebra, and whether there is displacement or compression of the nerves.

What is the treatment for spondylolysis and spondylolisthesis?

Treatment of spondylolysis and spondylolisthesis will depend on the severity of the condition. In mild cases, the initial treatment is usually conservative: with drugs, exercise or physiotherapy aimed at strengthening the muscles of the spine, infiltrations to reduce inflammation and pain. A brace or splint may also be indicated to immobilize the spine and allow the fracture to heal.

In severe cases, surgery may be necessary to repair the fracture and stabilize the spine. Surgery may consist of fusing the vertebrae or removing the damaged vertebra and replacing it with an artificial one. Surgery is usually recommended when conservative treatments have failed to relieve pain or when the injury involves severe nerve and/or spinal cord involvement.

Should spondylolysis and spondylolisthesis be operated on?

The type of surgery recommended will depend on the severity of the condition. Surgery may involve fusion of the vertebrae (usually with screws and metal plates) or removal of bone tissue or intervertebral discs to relieve nerve compression.

Can spondylolysis and spondylolisthesis be prevented?

Although it is not always possible to prevent spondylolysis and spondylolisthesis, it is important to maintain a healthy weight and exercise regularly to strengthen the muscles of the lower back. It is also important to adopt good posture and take frequent breaks when sitting for long periods of time.

If you are involved in high-impact sports such as running or basketball, it is advisable to wear appropriate protective equipment to reduce the risk of injury.

It is also important to pay attention to posture when lifting heavy objects.