Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Spondylolysis and Spondylolisthesis

A defect in the vertebral arch is called spondylolysis. The defect can be congenital, or may be caused by injury or overloading resulting in stress fracture. Spondylolysis creates the necessary conditions for one vertebra to be able to slip forwards in relation to the one below it. Once this has occurred the condition is called spondylolisthesis. The younger the individual in whom the arch defect occurs, the greater the risk of the vertebral body slipping forwards; the risk of slippage is very small after the age of 25 years.

The problems that arise are determined partly by the speed with which the slippage takes place and partly by its extent. Spondylolysis can in itself cause problems, including pain in the back and sciatica. These are
precipitated by a local effect on the nerves due to changes around the defect without any slippage having occurred. The symptoms of spondylolisthesis begin as the vertebral body slips forwards and begins to exert traction and compression on the nerve roots. In growing adolescents the symptoms often appear after physical exertion.

Spondylolisthesis may occur in about 3–7% of the population, and it is usually the fifth lumbar vertebra that is involved. In sports in which the back is exposed to heavy shear loads, for example gymnastics,
diving, javelin throwing, wrestling, weightlifting, and golf, a comparatively larger proportion of participants is affected. The injury occurs above all in growing adolescents taking part in sports involving frequent bending of the spine to extreme extended positions, e.g. in gymnasts and linemen in American football.

Symptoms and diagnosis

– Fatigue is accompanied by aching in the lumbar region in young people, most frequently after physical exertion.
– Sometimes sciatic symptoms develop in both legs, in which case pain on straight-leg raising is often seen in both right and left legs. Sometimes a step-off notch can be felt in the spine during examination.
– An X-ray examination should be done with the athlete in a position that triggers the pain.
– An early bone scan may show signs of tissue damage such as a stress fracture.
– A CT or MRI scan confirms the diagnosis.

Treatment

The athlete should:
– rest from painful activities until symptoms have resolved;
– consult a doctor for an opinion;
– continue training, in most instances, provided that the back is protected from overexertion, sciatic symptoms are absent, and the symptoms do not become worse. Exercises emphasizing flexion should be prescribed. Extension exercises should be avoided since they will increase shear stress across the defect. Young people below 16–18 years of age should avoid extreme movements in the lumbar region.

The doctor may:
– recommend a change of sport;
– prescribe rest when the injury is in its acute stage;
– prescribe physiotherapy with a back muscle program, give advice on lifting technique;
– prescribe a soft brace and a lumbar heat retainer;
– prescribe a rigid lumbar support such as the Boston brace for fatigue fractures;
– operate when other treatment has not been successful;
– keep growing adolescents who have had this condition under observation with annual X-ray examinations.

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