Spondylolysis and Spondylolisthesis

Spondylolysis refers to a defect in the pars interarticularis that makes it more susceptible to fracturing. This small bone is located in the spine’s facet joints and connects each vertebra, keeping them in perfect alignment. 

Spondylolisthesis is the condition in which a vertebra slips out of alignment, putting pressure on the one below it. Both spondylolisthesis and spondylolysis typically occur in the lumbar region of the spine.

Spondylolysis can be a result of spinal degeneration or genetic defects, both of which can lead to a fracture of the pars interarticularis. Spondylolysis can be present at birth or caused by overuse or repeated or traumatic injuries. Risk factors for spondylolysis include participation in high-impact sports, genetics and severe swayback (lumbar lordosis).

When it comes to spondylolisthesis, there are different types and each has its own respective cause. 

• Traumatic spondylolisthesis occurs when a disc moves out of place due to an injury.
• Congenital spondylolisthesis is a result of improper spinal formation in the womb.
• Pathological spondylolisthesis happens when a disease (like osteoporosis, arthritis, bone abnormalities or tumors) causes disc slippage.
• Isthmic spondylolisthesis is a result of spondylolysis. 
• Degenerative spondylolisthesis occurs due to aging — as you age, your discs shrink and lose water, which can cause your vertebrae to easily move out of place.
• Post-surgical spondylolisthesis occurs when a vertebra slips due to spinal surgery.

Risk factors of spondylolisthesis include birth defects, traumatic injuries, involvement in high-impact sports, genetics, lifestyle and age.

The most common symptom of spondylolysis and spondylolisthesis is lower back pain that radiates to your buttock and legs. This pain may worsen with movement, especially when bending forward or backward. You may also experience difficulty walking or standing, posture abnormalities and stiffness, tightness, tenderness and muscle spasms in your legs and lower back. 

In diagnosing your condition, your doctor may conduct a physical exam and ask you in-depth questions regarding your symptoms, medical history and lifestyle.

To confirm a diagnosis of spondylolisthesis and spondylolysis, your doctor may conduct a variety of imaging scans such as an X-ray, SPECT bone scan, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan. They may also ask you to perform the Michelis’ Test (also known as the unilateral extension test). In this test, you will be asked to stand on one leg at a time while you hyperextend the lumbar spine. If you experience pain, this could indicate spondylolysis.

A diagnosis of spondylolisthesis or spondylolysis is typically associated with spinal stenosis, which is the narrowing of the spinal canal that leads to compression of the spinal cord and nerves.

Typical treatment for spondylolysis includes conservative measures such as bracing, rest and physical therapy. Your doctor may recommend anti-inflammatories, muscle relaxants, epidural steroid injections or hot and cold therapy for pain management. 

Spondylolysis and spondylolisthesis typically don’t require surgery. However, if you also have spinal stenosis, significant spinal instability or pain, weakness in the legs or if your condition doesn’t improve with non-surgical remedies, surgical intervention may be recommended.

Follow up with your doctor annually so that they can accurately track your condition.