*Always
consult a doctor for pain that spreads down your leg or is
accompanied by tingling, numbness or weakness.
Isthmic Spondylolisthesis
Isthmic spondylolisthesis is a caused by a stress fracture in
a part of a vertebra. (A crack in a vertebra, without slippage,
is called spondylolysis.) A crack in a vertebra often doesn’t
heal because of the constant stress on the lower back.
Sports (such as gymnastics, football, and weightlifting)
that place repetitive, excessive stress on the lower vertebrae
and/or involve hyperextension of the spine increase
the risk of stress fractures. Sometimes a genetic weakness or
malformation in part of the vertebrae leaves a person predisposed
to stress fractures.
Not
all stress fractures in a vertebra result in slippage.
A stress fracture in a vertebra may cause it to disconnect from
the facet joints. This results in the vertebra slipping forward
over the vertebra below it - resulting in misalignment and narrowing
in the spinal canal. Spinal nerves may be compressed.
The degree of slippage can vary. An X-ray can show the degree
of slippage. The slippage may or may not progress.
Isthmic Spondylolisthesis starts with a stress fracture
in a part of a vertebra called the pars interarticularis (a
narrow piece of bone connecting the facet joints). Facet joints
are hinge-like joints attached to the back of each vertebra
(in pairs - one on each side of the back of the vertebrae)
that link the vertebrae together and allow the vertebrae to
move on one another.
About 5% of adults have isthmic spondylolisthesis,
though many are not aware of it.
Some people are surprised to find out they have a
slipped vertebra after having it show up on an x-ray.
The stress fracture most often occurs in early
childhood but the slippage often occurs later -
during periods of rapid growth. Slippage is uncommon after
adolescence.
Sometimes the slippage occurs in childhood, is present for years
without symptoms, but often accelerates disc degeneration later
in life.
Isthmic spondylolisthesis most commonly affects the bottom
vertebra in the lower back just above the sacrum (a triangular
shaped solid base consisting of 5
fused vertebrae).
Symptoms of Isthmic Spondylolisthesis
There may be no symptoms at all or there may intermittent or
chronic symptoms. Pain is the main symptom. There
may also be tingling, weakness or numbness radiating down the
buttocks and leg (sciatica), caused
by compression or irritation of nerve roots. Inflammation may
trigger muscle spasms, which cause pain, stiffness in the back
and sometimes an abnormal gait. Tightness in
the hamstrings is another fairly common symptom of isthmic spondylolisthesis
that can cause difficulty walking.
The symptoms usually flare up after
prolonged standing or walking and are relieved by rest. The
symptoms may be chronic or intermittent.
Spondylolisthesis does not always cause symptoms.
Treatment
Treatment depends on severity of slippage, the cause of the
slippage, the severity of the symptoms, and age of the person.
When a child diagnosed with spondylolisthesis, x-rays are taken
routinely to see if the slippage is progressing.
Though spondylolisthesis is a chronic condition, conservative
treatment is usually adequate. Surgery is rarely needed. If symptoms
are severe, a few days of bed rest may be necessary. Prolonged
bed rest, however, weakens the muscles that support the spine
and is counterproductive.
Avoid activities that stress the lower back such as lifting
heavy objects.
Exercise
Consult
a physician before starting an exercise plan. Do not do any
exercise that causes pain.
Stretching the muscles of the lower back relieve muscle spasms.
Stretching the hamstrings also helps. Strengthening
the muscles that support the lumbar spine – both back
and abdominal muscles are particularly helpful. Strong muscles
and ligaments help hold the vertebrae in place.
Low impact
aerobics tone the muscles in the back without placing undue
stress on the spine. Low impact aerobics include walking, swimming,
or riding a stationary bike or elliptical trainer. Aerobics also
help keep one’s
weight under control; being overweight increases stress on the
lower back.
Medication
Anti-inflammatory medications are
useful for short-term pain and inflammation. See
Medications for Pain and Inflammation.
Cold
When there
is a flare up of symptoms, applying ice packs to the area every
three to four hours for two to three days can reduce pain and
inflammation. Do not apply ice for over 20 minutes at a time
to prevent frostbite. Place a cloth between the ice and the
skin.
Heat
Applying heat to the area can relieve
muscle spasms. Apply heat for 20 - 30 minutes at a time, waiting
at least an hour between each application to prevent overheating
of tissues. Moist heat penetrates the tissues more quickly, and
penetrates more deeply than dry heat. A hot bath or shower also
helps to relax muscles
Bracing
Some physicians recommend wearing a lumbosacral brace. Bracing
relieves symptoms for some people.
Epidural Steroid Injections
An injection of steroids into the
epidural space surrounding the spinal cord may reduce pain and other symptoms caused
by compression or irritation of nerve roots. An epidural steroid injection is a minimally invasive procedure with rare but serious risks. It is used only after conservative therapies have not provided adequate relief.
Surgery
Surgery may be recommended
when conservative treatment fails to bring adequate relief and
symptoms are severe enough to interfere with everyday life. Surgery
may also be recommended when the affected vertebra continues
to slip further. Fusing the affected vertebra to the vertebra
below it (or fusing the lowest lumbar vertebra to the sacrum)
prevents further slippage. If a nerve root is being compressed,
bone or tissue compressing the nerve can be removed make more
room for the nerve.
Fortunately, the majority of cases respond to conservative treatment.
Always consult a physician to receive a proper diagnosis
and an appropriate treatment plan.
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