Spondylolysis and Spondylolisthesis

Spondylolysis

Spondylolysis is a bony defect (stress fracture or fracture in the pars interarticularis or isthmus) of
the posterior elements of the spine.
Fractures usually occur at the L5-S1 level and rarely at L4-L5 or higher. They can occur on one side
(unilateral) of the vertebra or on both (bilateral).
Risk factors for Spondylolysis include playing sports, such as gymnastics, football, diving, wrestling
or weightlifting, specifically chronic overextension (bending backwards).

Spondylolisthesis

Spondylolysis sometimes causes spondylolisthesis, which is when one vertebra, made instable by
the break in the pars interarticularis, slips forward on the vertebra below it.
Spondylolisthesis usually involves L4-L5 and L5-S1.
If the vertebral slippage is severe, nerve roots can be compressed.

Specific classifications of Spondylolisthesis

Type I Congenital. Results from a congenital malformation of the sacrum or neural arch of L5.
Allows slippage of L5 on sacrum. Most common in children.
Type II Isthmic spondylolisthesis. Most commonly affects persons 5 to 50 years old. Usually
mechanical stress that causes a stress fracture at the pars.
Type III Degenerative spondylolisthesis. Most common in the elderly. Associated with the normal
aging process.
Type IV Traumatic spondylolisthesis. Produce by acute fracture. Casting or a back brace is most
appropriate.
Type V Pathologic spondylolisthesis. Structural weakness caused by disease or tumors.

Grades of Spondylolisthesis

Management of Spondylolisthesis

Treatment is dictated by symptoms and the degree of vertebral slippage (grades I-IV)
Patients primarily report pain with extremes of lumbar motion, especially extension.
Symptoms include a deep ache in the lower back, pain that is worse with movement and
tightness in the hamstrings.
But not every slippage presents with pain or dysfunction. Management for grade I is to
prevent progression to grade II.

Lumbar Spondylolysis Video

http://www.spine-health.com/video/lumbar-spondylolysis-video
Interventions

By definition, the pathologies presented are inherent spinal instabilities, so treatments should be
designed to increase spinal stability.
Begin spinal conditioning slowly, focusing directly on the muscles that insert on the affected
vertebrae in order to increase stability.
Core stability is a key component. Research indicates training of the stabilizing muscles of the trunk
reduces pain and disability.
Progress slowly and avoid pain.
Quality of exercises is more important than quantity.
Despite research, spinal stabilization exercises are often neglected.

Flexibility Exercises

Hip flexor stretch

Supine hamstring stretch
Rectus femoris stretch
Iliotibial band stretch

Stabilization Exercises

Abdominal bracing
Supine alternate shoulder flexion with resistance
Long sit back extension with resistance avoid extension of the spine beyond the neutral position

Surgery

Surgery is rarely performed but reserved for high-grade slippage (grades III or IV).
Surgery also used for radicular pain, or pain that radiates into the lower extremity directly along the
course of a spinal nerve root.
Types of surgery include decompression laminectomy and fusion to stabilize the vertebral
segments.

Conclusion

Patients need to realize the need for activity modifications and implement effective strength and
activity routines.
Literature shows that the longer the symptoms are present before interventions, the less chance
there is for optimum recovery.
The cornerstone in the care of spondylolisthesis is application of abdominal and paravertebral
muscle strengthening exercises to provide dynamic support for the spine during activity and
avoidance of extreme lumbar extension.