Spondylolisthesis

Description

Spondylolisthesis is the slippage of one or more vertebrae, the bones of the spine. Many causes of slippage of the vertebra are possible; these include stress fracture (spondylolysis), which is often seen in athletes, and degenerative and congenital causes. Spondylolisthesis tends to occur in adolescent athletes. The stress fracture occurs because the mechanisms of repair fail to keep up with the damage caused by the repetitive force. Spondylolisthesis may or may not cause symptoms and may be found only on x-ray examination.

Common signs and symptoms

• Chronic dull ache in the low back that is worse with hyperextension and occasionally with flexion, such as bending at the waist

• Tightness of the hamstring muscles

• Occasionally, stiffness of the lower back

• Spasms of the muscles in the back

• Pain, numbness, or weakness affecting one or both lower extremities

• If chronic, wasting of affected muscles

• Loss of bowel or bladder function

Causes

Spondylolisthesis is most commonly caused by congenital or degenerative factors, but it may also be related to athletic activities that cause a stress fracture (spondylolysis) of the vertebrae. Rarely, it can occur because of an acute fracture from a sudden blow, severe trauma, or benign or malignant tumor.

Factors that increase risk

• Any sport that causes hyperextension (arching) of the back, either excessively with rotation or repetitively, especially football, gymnastics, diving, weight lifting, dancing, rifle shooting, wrestling, tennis, swimming, running, volleyball, track and field, rugby, and contact sports

• Poor physical conditioning (strength, flexibility)

• Inadequate warm-up before practice or play

• Family history of spondylolysis or spondylolisthesis

• Poor technique

Preventive measures

• Use proper sports technique.

• Wear proper protective equipment, and ensure a correct fit.

• Appropriately warm up and stretch before practice and competition.

• Maintain appropriate conditioning that includes back and hamstring flexibility, back muscle strength and endurance, and cardiovascular fitness.

Expected outcome

Spondylolisthesis is usually curable with appropriate treatment.

Possible complications

• Frequent recurrence of symptoms, resulting in a chronic problem; appropriately addressing the problem the first time decreases the frequency of recurrence.

• Chronic pain and nonhealing of the fracture

• Delayed healing or delayed resolution of symptoms, particularly if sports are resumed too soon

• Prolonged disability

• Progression to even greater slippage, depending on the cause of slippage and the age of the patient

General treatment considerations

Initial treatment consists of rest from the activities that cause pain, such as hyperextension, and medications and ice to relieve pain. As pain subsides, exercises to improve strength and flexibility and to learn proper back mechanics are started. Referral to a physical therapist or athletic trainer may be recommended for evaluation and further treatment, including transcutaneous electronic nerve stimulation (TENS). A back brace may also be recommended. Surgery may be necessary based on the cause of the spondylolisthesis, the age of the patient, degree of slippage, neurologic symptoms, and persistent pain despite appropriate conservative treatment. Surgery is performed to help the fracture to heal or, more often, to fuse two or more vertebrae together.

Medication

• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other over-the-counter pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers may be prescribed as necessary. Use these only as directed. Do not use any heavy machinery or drive a car while taking these medications.

Heat and cold

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. It should be applied for 10 to 15 minutes every 2 to 3 hours as needed and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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