Isthmic Spondylolisthesis During Adolescence

Isthmic spondylolisthesis is a common cause of back pain in adolescents.

It is suspected that spondylolysis, the fracture in the lower back that can lead to spondylolisthesis, occurs most frequently in young athletes who are involved in sports that involve repeated hyperextension of the lower back (bending backwards), such as gymnastics.

The most common symptom is back and/or leg pain that limits a patient's activity level. In cases of a more advanced slip, such as a grade 2 or more spondylolisthesis, the patient may have a noticeable forward curve or sway back in their lower back. Development of either neurological problems or paralysis is possible but exceedingly rare.

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Adolescent Spondylolisthesis Treatment

Adolescents involved in sports can develop back pain from their activity. If a spondylolisthesis is noted on x-ray, generally it is recommended that the athlete refrain from sports until he or she is free from pain.

The typical range of non-surgical treatments may be employed to manage pain, including:

  • Pain medications - NSAID’s and acetaminophen are good options
  • Ice and/or heat therapy – both are good options to relieve flare-ups of pain
  • Physical Therapy - Physical therapy can be useful, especially to stretch the hamstring muscles. The condition causes the hamstrings to tighten, and as they tighten they contribute to extra stress across the disc and the fracture. Stretching of the hamstrings interrupts the cycle of pain causing hamstring spasm leading to further back pain.

During adolescence, a small number of individuals will need surgical stabilization because of back pain that is unresponsive to non-surgical treatment. This, however, is unusual as in most cases the back pain will resolve with time and nonsurgical care, such as anti-inflammatory medication, gentle stretching, and physical therapy.

For a very small minority of adolescents, if they develop a grade two or more spondylolisthesis that is symptomatic, surgical stabilization with a spinal fusion is generally recommended to prevent further progression of the slip. Unlike spondylolisthesis in adults, in adolescents it is more likely that the slip may progress, and the morbidity (undesirable side effects and potential complications) of a spinal fusion surgery may be outweighed by the risk of progression of the deformity.

Read more about the causes of Back Pain in Children