The spine or the backbone performs one the most vital functions of supporting the entire body weight and also providing the flexibility to carry out routine activities. As a supporting pillar, the spine is all too often overused, and wear and tear is common, which may lead to problems such as back pain. Though intermittent episodes of back pain may go away with the use of heat pads and rest, chronic back pain is hard to tackle and won’t go without proper treatment. When back pain becomes a recurrent problem, it is most likely due to one of two different conditions known as spondylolysis and spondylolisthesis. Physicians who are members of the Texas Health Spine and Orthopedic Center referral line provide treatment options for a variety of spine conditions including spondylolysis and spondylolisthesis. Continuing the discussion, the blog post discusses and distinguishes between Spondylolysis and Spondylolisthesis, with special emphasis on the causes, diagnosis, and available treatment methods.
Spondylolysis and Spondylolisthesis: Basic Difference
Spondylolysis and Spondylolisthesis are interrelated conditions that affect the joints aligning the vertebrae, which are stacked on top of each other. These conditions are not always symptomatic and sometimes are just found incidentally on x-ray. Spondylolysis can be defined as a stress fracture or cracking of one of the vertebrae bones, precisely the fourth and fifth lumbar vertebra in most cases. If the stress fracture aggravates to a point wherein, the bone is weakened and no longer able to maintain its position in the spine and starts shifting or slipping out of place – the condition is referred to as Spondylolisthesis.
Both disorders are likely to affect young people and adolescents who play contact sports or other games, such as football, gymnastics or weight-lifting, which involve extensive stretching of the lumbar spine, also known as repetitive hyperextension. The causes can also be congenital, as some people are born with a spine that is thinner than normal and therefore, more susceptible to fractures. Nonetheless, any person can develop Spondylolysis or Spondylolisthesis during early stages of life as the spine is in the growing phase and the bones are vulnerable to fractures. If a person has Spondylolysis, the likelihood of developing Spondylolisthesis is even higher.
One of the classical and common symptoms of both disorders is lower back pain, which increases either after a period of motion or exercise. While pain due to Spondylolysis can feel more like a muscle strain, it further radiates to the buttocks and back of the thighs and often improves after a period of inactivity or rest. Spondylolisthesis, however, may lead to additional symptoms, such as back stiffness, tight hamstrings, leg pain (radiculopathy) and great difficulty in walking and standing. Those with high-grade slips can also experience numbness, weakness or a tingling sensation in either legs, due to increased pressure on the spinal nerve root.
Doctors usually begins the diagnosis with a physical exam, looking for visible symptoms such as swelling and tenderness or assessing the range of motion in the affected area. They may also refer to the patient’s medical history to check for back injuries in the past and can even ask questions about triggers of the pain, when it bothers the most, and what steps help ease it off. If physical diagnosis is insufficient in establishing either conditions, the doctor can order imaging or other medical tests for a clearer picture. The tests generally include:
X-rays can be helpful in determining stress fractures in the vertebrae indicating Spondylolysis, or vertebrae slippage, indicating the presence of Spondylolisthesis.
A CT scan can present a clear and comprehensive picture of the spine spinal bony anatomy, revealing fractures and out of place vertebrae, that might not be visible on plain x-rays. It is also helpful in planning the treatment.
MRI studies show soft tissue images in the back and can confirm whether a slipped vertebrae is pressing against the nerve roots, which may be Spondylolisthesis, and beyond the scope of X-rays.
The typical treatment goals for both Spondylolisthesis and Spondylolysis is to relieve pain, facilitate healing of the broken vertebrae, and restore mobility. Most cases show considerable improvement with nonsurgical treatments such as:
In cases of acute injury braces can help in strengthening the muscles of the lower back and immobilize the spine, thereby providing pain relief and promoting faster healing. They also help in easing the pressure in the lumbar region, preventing further slippage and spine injuries. Patients need to make significant lifestyle adjustments that include posture correction and sleeping habits. Braces are not helpful for chronic pars fractures.
Your doctor can also prescribe pain or anti-inflammatory medications such as Ibuprofen and Naproxen to deal with inflammation. Epidural steroid injections can also be administered directly to the spine for quick relief of back pain and inflammation.
Specific exercises can be prescribed by specialist doctors to improve the flexibility of the back and can also be combined with holistic methods, such as acupuncture, acupressure, and nutritional supplements.
If the pain doesn’t respond to the first line of treatment or there is a gradual worsening of the slippage due to Spondylolisthesis surgical repair may be required. The procedure is called Spinal fusion and is helpful in alleviating back pain and stabilizing the spine, allowing for the restoration of mobility. During the procedure, a surgeon first realigns the vertebrae, followed by placing a bone graft to fuse the loose vertebrae and prevent them from shifting out of place. In the event of high-degree slippages, the doctor may first need to ease off compression on the spinal nerves before proceeding with placement of the bone graft. The surgery achieves a decent success rate, and 90 percent of the patients are able to get back to normal activities free of pain.
The Bottom Line
Both Spondylolysis and Spondylolisthesis can take a toll on the life of patients, given the amount of discomfort and pain they cause. The disorders affect young and older people alike, although it is more common after 40 years of age. 4 to 6 percent of Americans are affected by the disorders to some degree. Interestingly, most of them lead normal lives for years without knowledge of the structural deficiency. If you or someone you know is has symptoms of the disorder, physicians who are members of the referral line at Texas Health Spine and Orthopedic Center can help. To learn more about the disorder or available treatment methods, book an appointment here or call us at 1-888-608-4762.
Disclaimer: Physicians who are members of the referral program practice independently and are not employees or agents of Texas Health Spine and Orthopedic Center.