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Spondylolysis & Spondylolisthesis

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What is spondylolysis?

Spondylolysis (pronouced spon-dee-low-ly-sis) is a defect of the spine, usually in the lower back. Specifically, it is a separation of the joint between two vertebrae that is typically caused by a stress fracture of the bone.

Spondylolysis affects 3 to 6 percent of the population and is most common in adolescents and young adults from the ages of 16 to 26.

What can cause spondylolysis?

There are several risk factors that can contribute to spondylolysis. These include:

  • Age and sex: spondylolysis is more prevalent in adolescent and young adult males
  • Participation in strenuous sports: repetitive lower back trauma can lead to increased stress on the lumbar spine (eg. Gymnastics, football, weightlifting, soccer)
  • Genetic factors: the bony anatomy of the spine can put certain individuals at a higher risk for spondylolysis

What is spondylolisthesis?

Spondylolisthesis (pronounced spon-dee-low-lis-thesisis a slipped or displaced vertebra relative to the one below it. It is most common in the lower back in the lumbar spine and can result in changes in posture and gait, tightness of the back and legs, pain, and sometimes tingling and numbness in the buttocks and legs. The amount displacement is measured by percentage and is graded based on severity.

  • Grade 1: 0 – 25%
  • Grade 2: 25 – 50 %
  • Grade 3: 50 – 75%
  • Grade 4: 75 – 100%

A slip greater than 100% is called a spondyloptosis when the vertebra completely displaces from the one below it.

Types

Isthmic Spondylolisthesis

“Isthmic” refers to a thin bony part (Isthmus) of a vertebra. This is the most common type of spondylolisthesis, which usually begins to develop between the ages of 6-16. Most occurrences of isthmic spondylolisthesis are Grade 1 or Grade 2.

Displastic Spondylolisthesis

This is a rare form of spondylolisthesis that is a result of a malformation of the vertebrae in the lumbar and sacral spine.

Traumatic Spondylolisthesis

This is another rare type of spondylolisthesis that results from trauma to the lower back.

Pathologic Spondylolisthesis

This can occur as a result of metastases or metabolic bone disease

Degenerative Spondylolisthesis

This only occurs in older adults where the vertebrae start to degrade over time



Diagnosis

Spondylolysis and spondylolisthesis are diagnosed by an X-ray and a physical exam. The doctor will look at how the vertebrae are structured relative to one another and look for damage to particular areas within the vertebrae.

Treatment

There are several different ways to treat spondylolysis and spondylolisthesis. The type of treatment selected depends on the type and amount of displacement.

Your orthopedic surgeon (bone and joint doctor) will discuss with you the possible treatment options for your back.

Conservative management

Modifying your activities, taking over the counter pain medications and physical therapy can help manage the symptoms caused by spondylolysis or spondylolisthesis

Surgical management

In severe cases of spondylolisthesis, the surgeon may recommend a surgery to correct the slip and prevent future problems.

Healthy li​​festyle

Regardless of the treatment that you and your doctor decide, it is important to maintain a healthy lifestyle!

  • Be physically active: yoga, pilates, and swimming are good activities to help develop core muscle strength.
  • Eat healthy: a good diet will help your overall body health.
  • Avoid unhealthy lifestyle behaviours (e.g. smoking).
  • Attend regular follow-up visits with your doctor and follow their recommendations regarding activity and lifestyle modifications
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