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Spondylolysis and Spondylolisthesis

What is spondylolysis?

Spondylolysis is a long word that means spine defect.

Children with spondylolysis have a problem in the bones (vertebrae) of their lower back. Usually, this problem is not present at birth (congenital), but develops over time.

Doctors think the defects may be due to tiny cracks in the bones (stress fractures). Often, overuse causes these cracks.

This problem may lead to spondylolisthesis.

What is spondylolisthesis?

Spondylolisthesis means spine slippage. In a normal backbone, the vertebrae are stacked on top of each other with disks in between them that act as shock absorbers.

When one of the vertebrae slides forward off the disk and onto the bone underneath it, it is called spine slippage.

If the slipping is severe, it can stretch the nerves in the lower part of your child’s back.

This can lead to:

  • Pain that radiates down one or both legs
  • A numb feeling in one or both feet
  • Weakness in your child’s legs
  • Trouble controlling her bladder or bowel movements

How do you evaluate spondylolysis and spondylolisthesis?

Slip displacement.
Slip displacement.

First we look for signs of cracks in your child’s vertebrae (stress fractures). We look for these first because spine slippage, though rare in children, typically happens to those who have the fractures.

The doctor will ask your child if the pain is worse when she arches her back. This is a common sign of stress fractures. Most often, these fractures are in the lower part of the backbone.

Next, we most likely will take X-rays of your child’s backbone to make sure she has a stress fracture. If we cannot see the crack clearly on the X-ray, we may ask to do a bone scan.

If we find a crack, we will probably take a three-dimensional X-ray called a CT scan. This will give us an even better look at the fracture and help you and your child’s doctor decide on treatment.

Who gets spondylolysis and spondylolisthesis?

These two conditions are the most common causes of ongoing (chronic) back pain in children. As many as 6% of children may have spondylolysis by the time they are age 6.

Children who take part in sports that require them to arch their backs a lot get stress fractures in the backbone more often than other children do. Gymnasts, down linemen in football, volleyball players and swimmers who do the butterfly stroke are the most likely to have this problem.

How do you treat spondylolysis and spondylolisthesis?

Most children with these problems do not need surgery.

At Children’s we offer exercise programs (physical therapy) to strengthen your child’s muscles. We may also ask your child to temporarily stop doing the activity that is causing the injury.

Back braces

For some children, back braces can take the pressure off the lower back and relieve the pain so they can return to sports and school.

The braces flatten out the normal curve (lordosis) of the lower spine. Your child will wear the brace as she moves about during the day. Typically, children wear a brace for two to three months.

As the symptoms of pain decrease, your child can slowly decrease the amount of time she wears the brace. Read about braces and our other orthotics and prosthetics services.

Surgery for spondylolysis and spondylolisthesis

If your child’s pain continues after rest and bracing, she might need surgery to fix her fracture or stop the slipping. At Children’s, we offer two operations to treat these conditions. We will discuss each option with you and your child to decide which is likely to work best.

In one operation, the doctor repairs vertebrae by placing a metal implant across the fracture and using a bone graft to help healing.

In the other operation, the doctor joins two or more vertebrae together (fusion) to make your child’s back more stable. To do this, the doctor places screws into the bones of your child’s lower spine and connects them with a bar to hold the spine still. Next, he places a bone graft in the area to help the bones grow together.