Spondylolisthesis

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The orthopedic specialists at Cook Children's have extensive experiencing in caring for kids and teens with spondylolisthesis. Recognized for their excellent care of children with spine injuries and disorders, they can evaluate and create a unique plan of care for your child.

Spondylolisthesis happens when the front part of a vertebra (bone in the spine) slides away from the back part. In kids and teens, it's often a complication of spondylolysis, and is a common cause of lower back pain in these age groups.

Spondylolisthesis is usually mild and heals with rest and other "conservative" (or nonsurgical) treatments. However, sometimes it can be severe and may require surgery to fix the problem.

The spine (or backbone) has 33 bones called vertebrae (VER-tuh-bray). Nine vertebrae are fused together to form the tailbone, and the other 24 are in the back. The lumbar vertebrae are in the lower back and closest to the tailbone. This is where spondylolisthesis usually happens.

Sometimes the front and back parts of one of the vertebra aren't connected. This happens because of a fracture (break) in the part of the vertebra called the pars (or pars interarticularis). Each vertebra has two pars, one on the left side and one on the right. If both pars are fractured, the front part of the vertebra can slide away from the back part.

Most of the time, the front slides away only a little bit. But if it slides away a lot, it can cause the spinal cord and nerve roots to become pinched.

Some kids are born with a spondylolisthesis and some cases probably are genetic (passed down by parents to their children). Spondylolisthesis can get worse while kids are growing and even into adulthood.

Many people with spondylolisthesis don't realize that they have it. Their backs might feel just fine despite a vertebra being out of place. When there are symptoms, they often include:

Pain in the lower back that might feel like a muscle strain
Pain in the thighs and buttocks
Stiff muscles and tenderness in the lower back
Muscle tightness, especially in the hamstring muscles

If the vertebra slips far enough to press on the spinal cord or smaller nerves, it can cause increased pain and, in more serious cases, nerve damage. Signs of this include:

Pain that radiates down the legs
Weakness in the legs or trouble walking
Trouble peeing or bladder accidents
Numbness and tingling in the groin and/or buttocks

Young people are more at risk for spondylolysis and spondylolisthesis because their bones are still growing, especially during a growth spurt.

Kids and teens who play sports and do activities that can strain the lower back or that involve a lot of lower-back stretching — like football, weightlifting, gymnastics, volleyball, ballet, golf, and wrestling — are especially likely to have these problems.

Besides doing a physical exam, your child's doctor will order X-rays of the lower back to look for spondylolisthesis. X-rays can show if a vertebra has slipped out of place.

Depending on your child's symptoms and X-ray results, other imaging tests may done — such as a CT (computed tomography) scan or a lumbar MRI scan — to get a better look at the back and to see if the slipped vertebra is affecting the nerves.

In many cases, spondylolisthesis gets better by resting and doing exercises designed to stretch and strengthen the back. Only in rare cases is surgery needed to fix the condition.

As with spondylolysis, your child's doctor will probably will recommend:

A break from sports and other strenuous activities
Plenty of rest
Core-strengthening exercises that don't strain the lower back
Flexibility training
Physical therapy
Sports physical therapy
Medicine to help ease pain and swelling

Conservative treatments usually are enough to fix the pain from spondylolisthesis. However, more severe cases may require a surgical procedure. In surgery:

The bone that has slipped forward is moved back into place (this is called a reduction).
Another piece of the vertebra is removed to take pressure off of the nerves (this is called a decompressive laminectomy).
Rods and screws are put in to hold the spine in place while it heals and the bones fuse together, making them more stable (this is called a spinal fusion).

If your child is diagnosed with mild spondylolisthesis, it's extremely important to ensure that they follow the treatment and recovery plan. If mild spondylolisthesis doesn't heal properly, it can result in lifelong chronic back pain and a loss of flexibility.

Spondylolisthesis is hard to prevent because it can happen all at once or over time. A child or teen who has spondylolysis can help prevent it progressing to spondylolisthesis by taking the time to rest and heal as the health care provider directs.

Young athletes can help lower their risk of these and other back problems by:

Limiting time spent on high-risk sports
Resting and recovering after physical activities
Keeping core muscles strong
Warming up properly before playing any sports
Stretching regularly
Using safety equipment correctly
Following the rules and techniques for their sport or activity
Maintaining a healthy weight

The sports and activities that can cause spondylolysis and spondylolisthesis often are very competitive and attract motivated, driven kids and teens (and parents). So it's important to keep your child's temperament in mind when dealing with these problems and their recovery.

Besides their own wishes to return to what they love, kids and teens also might be under pressure to get back into the game from coaches, teammates — and even parents. But a safe return to play is very important. Your child should get the OK from their doctor before they return to any physically demanding activities and sports.

After recovery, kids and teens need to keep up with the proper techniques and sports safety measures they learned. They should maintain their core strength and flexibility, and take breaks between sports seasons, games, and competitions.

Also, be sure that your child knows to immediately stop doing any activity that causes back pain. They should see their doctor as soon as possible, and not return to play until the pain goes away.

We're here to help.

If you'd like to schedule an appointment, refer a patient or speak with us, please call our main office at 682-885-4405. You can also reach out to one of our clinic locations.

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