In spondylolisthesis, the fractured pars interarticularis separates, allowing the injured vertebra to shift or slip forward on the vertebra directly below it. In children and adolescents, this slippage most often occurs during periods of rapid growth — such as an adolescent growth spurt.
Doctors commonly describe spondylolisthesis as either low grade or high grade, depending upon the amount of slippage. A high-grade slip occurs when more than 50% of the width of the fractured vertebra slips forward on the vertebra below it. Patients with high-grade slips are more likely to experience significant pain and nerve injury and to need surgery to relieve their symptoms and prevent further deterioration.
Spondylolisthesis is more likely to occur in young people who participate in sports that require frequent overstretching (hyperextension) of the lumbar spine — such as gymnastics, football, and weightlifting. Over time, this type of repetitive activity can weaken the pars interarticularis, leading to fracture and/or slippage of a vertebra.
In many cases, patients with 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
The majority of patients with spondylolisthesis are free from pain and other symptoms, sometimes within a few weeks or over several months. In most cases, the patient can gradually resume sports and other activities with few complications or recurrences.
To help prevent future injury, the doctor may recommend that your child do specific exercises to stretch and strengthen the back and abdominal muscles. In addition, your child will need regular check-ups to ensure that problems do not develop.
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