Spondylolisthesis is a condition where one of the bones of the spine (vertebrae) slips out of place and over the vertebra below it, and usually affects the lower back (lumbar spine). Spondylolisthesis in children is often caused by repeated hyperextension of the back during activities such as gymnastics, football or wrestling.
Stretching for 30 minutes before participating in sports can help prevent injury in growing children.
The physicians at Medical City Children’s Orthopedic and Spine Specialists take care of all types of sports-related injuries, including spondylolisthesis. In case of an injury, we can see your child right away, and you never have to wait long for an appointment. With convenient locations in Dallas, Frisco and McKinney, we are never far away.
Isthmic spondylolisthesis. This type of spondylolisthesis is related to another condition, spondylolysis (also referred to as Pars Defect), which is a fracture(s) in a small piece of bone that connects facet joints called the pars interarticularis (meaning “the space between two joints”). This type of spondylolisthesis can affect people of all ages, but it is much more common in children and adolescents due to the fact that their bones are still developing.
Congenital spondylolisthesis. Also referred to as dysplastic spondylolisthesis, congenital spondylolisthesis is the result of abnormal bone formation before birth. Congenital spondylolisthesis can cause stress on the pars interarticularis, causing fractures that may lead to a vertebral slip.
Other, less common forms of spondylolisthesis include:
Traumatic spondylolisthesis. Caused by trauma to the vertebrae resulting in a spinal fracture or a vertebral slip.
Pathological spondylolisthesis. Pathological conditions, including infection or cancer, can cause the bones of the spine to become weak, leading to fractures and vertebral slip.
Post-surgical spondylolisthesis. As the name suggests, this type of spondylolisthesis occurs or worsens following spinal surgery.
Spondylolisthesis is a fairly common cause of back pain in teens, who often begin showing symptoms during the teenage growth spurt. Overuse in sports that put a strain on the lower back can contribute to the condition. Warming up and stretching, especially during the growing years, is vitally important.
The most common symptom of spondylolisthesis is pain that starts in the lower back and spreads to the rest of the back and the legs. Spondylolisthesis is often mistaken for a simple back strain, and muscle spasms are another common symptom. In fact, many parents don’t realize their child has a serious issue until they are seen by an pediatric orthopedist.
Other common symptoms include tightness, pain, and muscle spasms in the legs, thighs and buttocks, which can force the person to walk with an unnatural gait. In addition, the slipped vertebra can press on the nerve, causing pain, numbness and tingling in the legs and feet.
After reviewing your child’s medical history, the physician at Medical City Children’s Orthopedics and Spine Specialists will perform a physical examination, looking carefully for any pain, problems with balance or gait, as well as any loss of muscle reflexes or muscle weakness.
X-ray imaging of the lower back can show if a vertebra is out of place. However, the physician may order additional tests, such as a computed tomography (CT) or magnetic resonance imaging (MRI) scan, to see if any nerves or other soft tissues are involved in the injury.
Spondylolisthesis is becoming more common among teenagers
“With spondylolisthesis, when the vertebra slips before the age of 10, it is more likely to be a big slip as teenagers. At Medical City Children’s Orthopedic and Spine Specialists, our board-certified physicians are specially trained in spinal injuries and specifically treat children and adolescents, so we understand the complexities of growth plates for children’s growing bones.” Shyam Kishan, MD
Treatment options for spondylolisthesis range from rest and medication to surgical intervention, and depend largely on age of your child and their overall health, as well as the severity of the vertebral slip.
The most common course of treatment is a conservative one that involves rest (and taking a break from any sports activities), medication to treat the symptoms, and specialized exercises and physical therapy. Typical medications include over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), but stronger medications might be prescribed if these do not provide relief. Epidural steroid injections in the space surrounding the spine may also help reduce inflammation and ease pain.
Exercise and physical therapy can strengthen the muscles of the back and abdomen and minimize movement of the spine. We generally recommend 8 to 12 weeks of aggressive, daily stabilization exercises to achieve clinical improvement.
Additionally, a brace or back support may be used to help stabilize the lower back and reduce pain, and an exercise and/or physical therapy program will help increase pain-free movement and improve flexibility and muscle strength. We will periodically take X-rays to determine if any bone slippage persists.
Most patients with minor to moderate spondylolisthesis are able to recover within 8-12 weeks with a conservative treatment approach. In addition, there are steps you can take as a parent to decrease the risk of your child developing spondylolisthesis. Helping them maintain a healthy weight is the best thing to do, and exercises that strengthen the back and abdominal muscles can also help them a great deal. Try helping them choose activities that don’t put as much stress on their lower back, such as swimming, biking, and stretching/core-building exercises.
If conservative treatment is not enough to stabilize the spine and relieve the pain and swelling, surgery may be necessary.
Two surgical procedures commonly used to treat spondylolisthesis include:
Decompressive laminectomy. This surgical procedure involves carefully removing the portion of the bone or other tissue that is pressing on the nerves. While this surgery can relieve much of the pain, it may leave the spine somewhat unstable, so it’s usually done in conjunction with a spinal fusion.
Spinal fusion. In order to stabilize the spine and prevent motion which could damage it further, two or more of the vertebrae are fused together so that as they heal, they become one solid bone. This procedure can lead to some loss of spinal flexibility, but it more than makes up for it by preventing motion and slippage that can lead to further injury and pain.
Following a surgery, patients are typically kept for observation for a few days. During this time, the physicians and physical therapists at Medical City Children’s Orthopedics and Spine Specialists will teach you and your child movements to avoid, and your child may have to learn new ways to walk, sit and stand safely while their spine heals. After the hospital stay, your child might require a brace to keep the spine properly aligned. Full recovery usually takes 3-6 months.
“Spondylolysis is a condition which commonly affects children in their growing years. A part of the back of the spine called the “pars” is injured with a small stress fracture, and this can lead to a condition known as spondylolisthesis, where one of the bones slips down over another, causing pain and significantly reducing their activity level.” – Dr. Shyam Kishan
Call 214-556-0590 to make an appointment.
Comprehensive services for children from birth through adolescence at three convenient locations: Dallas, Frisco and McKinney.