Spondylolysis and Spondylolisthesis

Spondylolysis is the medical term for a spine fracture or defect that occurs at the region of the pars interarticularis. The pars interarticularis is region between the facet joints of the spine and more specifically the junction of the superior facet and the lamina.

Spondylolisthesis is the medical term used to describe the forward slippage of one spine bone on another.

Quite often, a person who has spondylolysis will also have some degree of spondylolisthesis. However, a person may have a spondylolysis without having spondylolisthesis, and a person may have spondylolisthesis without having a spondylolysis.

It is more common for a child or young adult to have a spondylolysis without having spondylolisthesis, whereas adults are frequently diagnosed with spondylolisthesis without spondylolysis. Although it is confusing, both of these conditions are frequently seen in combination, and the treatments for both conditions are often the same. However, it is much more common for adults to be treated surgically. Children with spondylolysis/spondylolisthesis rarely require surgery unless the slippage is severe.

How are spondylolysis and spondylolisthesis diagnosed?

The diagnosis of spondylolysis and/or spondylolisthesis may be suspected, particularly if the above-mentioned physical findings are present. An X-ray or CT scan is required to confirm the diagnosis, as well as to grade the severity of the condition.

What are the treatment options?

The treatment of adult patients with spondylolysis and/or spondylolisthesis depends on the severity of the pain, nerve compression and slippage. Nearly all patients are recommended for conservative treatment initially unless there is a severe neurologic deficit such as leg weakness and numbness. Physical therapy, chiropractic care and oral medications are frequently prescribed. Epidural steroid injections and/or nerve root blocks may also be utilized for severe pain or moderate pain that is no longer responding to other conservative measures. Patients who do not benefit from these conservative measures are usually candidates for surgical intervention.

The recommended surgery for adults with spondylolysis and/or spondylolisthesis who have failed nonoperative measures is spinal fusion. The goal of surgery is to stabilize the levels of the spine that are “slipping” by placing bone graft and metal rods and screws. Adult patients with significant stenosis generally require laminectomy and decompression, whereas children do not. The instrumentation fixes and holds the bones in place immediately, while the bone graft fuses the unstable spine bones together. After the fusion surgery is performed, it takes approximately four to eight months for the bones to solidly mend together. Most patients are recommended to wear only a small plastic brace or soft corset, if anything, for two to three months after surgery to help the fusion solidify.

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