What are Spondylolysis and Spondylolisthesis?
Spondylolysis comes from the Greek words “spondylo” (spine), “lysis” (breakdown), and “Olisthanerin” (to slip). Spondylolysis is a stress fracture of part of the vertebral body (spine). Spondylolysis usually involves both sides of the vertebra (bilateral) while involvement of only one side usually occurs with trauma.

Spondylolisthesis occurs when the vertebral body (spine) slips forward on the next vertebral body. This happens after a spondylolysis has occurred. The most common site for spondylolisthesis in the child is where the lumbar spine meets the sacrum (at L5 on S1).

What is the incidence of spondylolysis and spondylolisthesis?
Spondylolysis and spondylolisthesis may be incorrectly considered as congenital abnormalities. They are rarely diagnosed before 5 years of age. The incidence rises at 7-8 years and stabilizes at age 20. The overall incidence is 4-6%.

What are the causes?
Genetic, traumatic, and developmental causes have been theorized. Repetitive trauma is the most widely considered cause with an 11% incidence in adolescent athletes including female gymnasts, weight lifters and football players. Unfortunately, girls are more prone to severe displacement which usually happens around puberty, during their rapid growth spurt.

What are the physical findings?
Clinical findings include back pain, postural deformity, and abnormal gait from tight hamstrings. The physical findings typically correlate with the degree of slippage. There may be a palpable step-off, restricted motion of the lumbar spine, increased lordosis (swayback), loss of buttock contour, torso shortening, and a pelvic waddle.

Will any x-rays be taken?
Probably, though other radiologic studies may also be taken, including SPECT scan (bone scan), CT or MRI.

What is the treatment?
Treatment includes rest, activity modifications, non-steroidal anti-inflammatory medicines, exercises, traction, bracing, and casting. All children or adolescents with bilateral spondylolysis should be followed closely for development of spondylolisthesis. Unfortunately some children fail conservative therapy and require spine surgery.