What is Spondylolisthesis ? #spondylolisthesis #sciatica #backpain #l4l5 #discbulges #backinjury

What is Spondylolisthesis ?

Spondylolysis is a crack or stress fracture in one of the vertebrae, the small bones that make up the spinal column. The injury most often occurs in children and adolescents who participate in sports that involve repeated stress on the lower back, such as gymnastics, football, and weight lifting.

In some cases, the stress fracture weakens the bone so much that it is unable to maintain its proper position in the spine—and the vertebra starts to shift or slip out of place. This condition is called spondylolisthesis.

For most patients with spondylolysis and spondylolisthesis, back pain and other symptoms will improve with conservative treatment. This always begins with a period of rest from sports and other strenuous activities.

Patients who have persistent back pain or severe slippage of a vertebra, however, may need surgery to relieve their symptoms and allow a return to sports and activities.

Spondylolysis and Spondylolisthesis

Spondylolysis and spondylolisthesis are different spinal conditions—but they are often related to each other.

Spondylolysis

In spondylolysis, a crack or stress fracture develops through the pars interarticularis, which is a small, thin portion of the vertebra that connects the upper and lower facet joints.

Most commonly, this fracture occurs in the fifth vertebra of the lumbar (lower) spine, although it sometimes occurs in the fourth lumbar vertebra. The fracture can occur on one side or both sides of the bone.

The pars interarticularis is the weakest portion of the vertebra. For this reason, it is the area most vulnerable to injury from the repetitive stress and overuse that characterize many sports.

Spondylolysis can occur in people of all ages but, because their spines are still developing, children and adolescents are most susceptible. Many times, patients with spondylolysis will also have some degree of spondylolisthesis.

Spondylolisthesis

If left untreated, spondylolysis can weaken the vertebra so much that it is unable to maintain its proper position in the spine. This condition is called spondylolisthesis. Spondylolysis (pars defects) create a change in the biomechanics of the spinal segment. Because the connection between the facet joints is broken, the bone above can begin to gradually slip forward on top of the bone below. This “slip” caused by the spondylolysis is called spondylolisthesis. As the slip progresses, the disc between the bones is subjected to increased stress, leading to accelerated disc degeneration.

Doctors commonly describe spondylolisthesis as either low grade or high grade, depending upon the amount of slippage. A high-grade slip occurs when more than 50 percent of the width of the fractured vertebra slips forward on the vertebra below it. Patients with high-grade slips are more likely to experience significant pain and nerve injury and to need surgery to relieve their symptoms.

The pars interarticularis is a narrow bridge of bone found in the back portion of the vertebra. (Center) Spondylolysis occurs when there is a fracture of the pars interarticularis. (Right) Spondylolisthesis occurs when the vertebra shifts forward due to instability from the pars fracture.

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