08/01/2021
🗒️Spondylolysis & spondylolisthesis
Spondylolysis and spondylolisthesis are conditions affecting the facet joints that align the vertebrae one on top of the other. ➡️Spondylolysis is a weakness or stress fracture in the facet joint area. This weakness can cause the bones to slip forward out of normal position, called spondylolisthesis, and kink the spinal nerves. Treatment options include physical therapy to strengthen the muscles. A back brace may be used to support the spine. In some cases, surgery can realign and fuse the bones.
Spondylolysis (spon-dee-low-lye-sis) and spondylolisthesis (spon-dee-low-lis-thee-sis) are separate, yet related conditions. ➡️Spondylolysis usually comes first, though not always. The term comes from "spondylo," which means spine, and "lysis," which means to divide. Spondylolysis is a breakdown or fracture of the narrow bridge between the upper and lower facets, called the pars interarticularis. It can occur on one side (unilateral) or both sides (bilateral) and at any level of the spine, but most often at the fourth or fifth lumbar vertebra. If spondylolysis is present, then you have the potential to develop spondylolisthesis.
➡️Spondylolisthesis is the slipping forward of the vertebral bone. The term "listhesis" means to slip forward. It occurs when the weakened pars interarticularis separates and allows the vertebra to move forward out of position causing pinched nerves and pain. Spondylolisthesis usually occurs between the fourth and fifth lumber vertebra or at the last lumbar vertebra and the sacrum. This is where your spine curves into its most pronounced "S" shape and where the stress is heaviest.
🔴Slippage is measured on a scale from grade 1 slippage (25%) to grade 4 (100%). The more the lower back curves in (swayback or lordosis), the steeper the grade.
🔴Symptoms
In many cases, patients with spondylolysis and spondylolisthesis do not have any obvious symptoms. The conditions may not even be discovered until an x-ray is taken for an unrelated injury or condition.
When symptoms do occur, the most common symptom is lower back pain. This pain may:
➡️Feel similar to a muscle strain
➡️Radiate to the buttocks and back of the thighs
➡️Worsen with activity and improve with rest
In patients with spondylolisthesis, muscle spasms may lead to additional signs and symptoms, including:
➡️Back stiffness
➡️Tight hamstrings (the muscles in the back of the thigh)
➡️Difficulty standing and walking
➡️Spondylolisthesis patients who have severe or high-grade slips may have tingling, numbness, or weakness in one or both legs.
These symptoms result from pressure on the spinal nerve root as it exits the spinal canal near the fracture.
🔴Since spondylolysis is the most common cause of spondylolisthesis, it may be referred to as an isthmic spondylolisthesis and sometimes these terms are used interchangeably, although this is not correct. There are at least 6 recognized causes of slippage as seen in spondylolisthesis in the literature. According to Dr. Leon Wiltse, these causes are listed as:
➡️Dysplastic spondylolisthesis (which includes congenital)
➡️Isthmic spondylolisthesis (which includes lytic or stress fracture, an elongated but intact pars or an acute fracture of the pars)
➡️Degenerative spondylolisthesis (Pseudospondylolisthesis) — secondary to long-standing degenerative arthrosis (degenerative disc disease and degeneration of the facet joints)
➡️Traumatic spondylolisthesis (secondary to a fracture of the neural arch)
➡️Pathologic spondylolisthesis (from bone disease such as metastatic disease, tumor, osteoporosis, etc.)
🔴Exercises for pain relief
After a thorough evaluation, physical therapist will be able to provide you with a personalized home exercise program to help decrease pain due to spondylolisthesis.
This program often includes lumbar flexion exercises, core stabilization exercises, and exercises or stretches for the muscles of the back, hamstrings, and hips. Low-impact exercise such as cycling or swimming is also recommended to promote healing and decrease pain.
🔴3 Exercises to Avoid With Spondylolisthesis
Since your spine can be very vulnerable while you’re suffering from spondylolisthesis, certain exercises may cause extra stress on the back. It’s important to speak with your doctor about your specific condition before further harming your back or spine.
Here are three spondylolisthesis exercises to avoid:
➡️Heavy weightlifting: Weightlifting, especially if you use improper lifting techniques, can take a toll on your back in many ways. While lifting, you’re placing extra strain on your back, specifically on your lower or lumbar region.
➡️Twisting or bending: Although core exercises for spondylolisthesis can be vital in strengthening your abdominal muscles and your back, make sure to avoid those that involve excessive twisting to the side or bending over such as toe touches. This may cause further injury to your spine and cause additional pain.
➡️High impact activities: It’s important to remain active during your recovery process from spondylolisthesis, but it’s advised to stray away from those exercises that may cause harm to your back. Exercises such as running, basketball, football, etc. should be avoided until you’re healed.