Spondylolysis and spondylolisthesis

Spondylolysis is a defect (crack) in part of a vertebra called the pars. Spondylolisthesis is the slipping forward of a vertebra through this fracture. Spondylolisthesis is often due to spondylolysis. But a child can have one without the other. If your child has this spine problem, he or she may see a spine specialist.

Causes

One common cause of these problems is repeated extension of the spine (bending backward). Children who do activities that require spine extension (such as gymnastics, diving and dance) are more likely to get these problems than other children. Other activities that may increase a child's risk include weightlifting. Sports like football and soccer may also make the problems more likely.

Signs and symptoms

These problems almost always occur in the lower back. A child can have either problem and have no symptoms or, he or she can have back soreness, back pain, or muscle spasms in the back. The pain can sometimes travel into the thighs and buttocks. If your child has numbness, tingling, and/or bathroom difficulties, he or she should be evaluated.

Diagnosis

The doctor will ask about the child's activities and medical history. An X-ray (test that creates images of bones) is usually the only test that is needed. The problem often can be seen on an X-ray. In certain cases, other imaging tests (such as an MRI or a CT scan) may be done to get more information about your child's spine.

Treatment:

These problems can't be cured, but will often stop causing problems eventually. In the meantime, your child's symptoms can be treated with one or a combination of the following:

• Medications:To help reduce back pain and swelling, medications may be prescribed. These are usually NSAIDs (nonsteroidal anti-inflammatory drugs). These medications include ibuprofen and naproxen. They may be over-the-counter or prescription. Your health care provider will tell you what types and dosage are best for your child. Give these medications to your child only as prescribed.
• Physical therapy: Stretching and strengthening the muscles around the spine and in the legs can help relieve symptoms due to these conditions. Your doctor may refer your child to a physical therapist (PT) for a course of physical therapy and exercises.
• Resting the back: This means stopping any activity that stresses the back. Once your child stops having symptoms, he or she can go back to a normal activity level. If a child continues to have symptoms, a small reduction in activity may help.
• Bracing:Your child may be fitted with a brace to wear for a few weeks to months. This brace takes stress off the spine, allowing symptoms to resolve.
• Surgery: If spondylolisthesis is severe or can't be treated with nonsurgical means, surgery may be done. During surgery, the slipping vertebra is fused to the vertebra below it to prevent further movement.