Spondylolysis / Spondylolisthesis

What is spondylolysis / spondylolisthesis?

Spondylolysis is a defect or fracture of part of the vertebral bones called the pars interarticularis.  It usually occurs in the fifth lumbar vertebra and, less commonly, in the fourth lumbar vertebra.  Spondylisthesis is a slippage of one vertebral body on top of another.

What causes spondylolysis / spondylolisthesis?

Spondylolysis can be attributed to a number of factors, including genetics, overuse activities (particularly those with hyperextension involvement such as football and gymnastics), and previous surgery.

Spondylolisthesis occurs when there is weakening of the restraining structures of the spine.  This can be due to spondylolysis, congenital factors, degeneration of the spine, trauma, and cancer.

What are the symptoms of spondylolysis / spondylolisthesis?

Most people with spondylolysis / spondylolisthesis are asymptomatic and are unaware they have the condition.  When symptoms are present, however, they may include:

  • Low back pain
  • Feeling of "śhamstring tightness"ť
  • Pain radiating down the legs
  • Difficulty with upright posture and gait

How is spondylolysis / spondylolisthesis diagnosed?

In addition to a complete history and physical examination, diagnostic procedures for spondylolysis/spondylolisthesis may include the following:

  • x-ray - a diagnostic test which uses invisible energy beams to produce images of bones onto film.

  • computed tomography scan (also called a CT or CAT scan) "“ a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs.

  • magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in an intervertebral disc, vertebral body, spinal cord, nerve roots, ligaments, and muscle.

  • radionuclide bone scan - a nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient's bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.

  • selective anesthetic injection "“ a needle is introduced through the skin into a specific anatomic area usually to inject a combination of local anesthetic and corticosteroid under radiographic guidance.

Treatment for spondylolysis / spondylolisthesis

Specific treatment for sciatica will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Spondylolysis / spondylolisthesis symptoms usually improve with rest and time. To help relieve the pain, treatment may include:

  • nonsteroidal anti-inflammatory medications
  • bracing
  • physical therapy
  • if symptoms persist or the slippage continues, surgery to fix the bony defect or fuse the spine may be suggested by your surgeon

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