These are two very frequently related pathologies. It usually affects the lumbosacral region. Spondylolisthesis is that the sliding of 1 vertebra over another, usually forward (anterolisthesis). It can be accompanied by spondylolysis, which is the defect of union or fracture in a part of the vertebra (isthmus or pars interarticularis) of the degenerative, traumatic, or congenital cause that causes instability. When we find displacement (spondylolisthesis) without spondylolysis, it is generally due to degenerative alterations.
what spondylolysis and spondylolisthesis are
We speak of spondylosis when there is a tear (lysis means tear) in the lamina of the vertebra. Some people are born with this injury, but others develop it as a result of the tensions that their vertebrae endure when they practice a sport in which the spine is stretched and turned sharply, or due to direct trauma.
Spondylolysis are often caused by:
- A birth defect within the spine, which usually appears a couple of years after birth.
- Acute trauma to the back.
- Over chronic extension of the back produced by certain sports activities.
- Degenerative conditions of the spine.
Instead, we speak of spondylolisthesis when there is a displacement (olisthēsis which means dislocation or displacement) of a vertebra with respect to the lower one. This injury can be caused by associated spondylosis, or by an interpophyseal osteoarthritis, without the need for rupture.
It occurs between the fifth bone within the lumbar region (lumbar vertebra) and therefore the first bone within the sacral area (pelvis). it’s often thanks to a congenital anomaly therein area of the spine or a sudden injury (acute trauma).
There are two types of spondylolisthesis:
- Antherolisthesis: the upper vertebra moves forward over the lower vertebra.
- Retrolisthesis: the upper vertebra moves backwards over the lower one.
Spondylosis does not have to show symptoms since there may be rupture but without displacement. The moment there is displacement (spondylolisthesis) is when symptoms begin to appear.
The symptoms of spondylolisthesis depend on the degree of the lesion.
- 1: displacement less than 25%
- 2: offset between 25 and 50%
- 3: offset between 50 and 75%
- 4: displacement of more than 75%
Generally, grades 1 and 2 are not usually a cause of back pain or low back pain. When the displacement is greater, nerve compression or sciatica can occur causing:
- Muscle tension
- Tenderness in the area of the injured vertebra
- Pain, numbness, or tingling within the thighs and buttocks
- Leg weakness
Treatment for spondylolysis and spondylolisthesis
Treatment depends on the severity of the vertebral displacement. Most people improve by seeing a physical therapist or osteopath and following their recommendations on stretching and strengthening exercises that they should do daily. Only in the most severe cases, in which there is strong nerve compression, is surgery necessary to fuse the vertebrae.
- Heat or ice application
Application of heat or ice, to reduce localized pain. In general, ice is suggested to alleviate pain or discomfort immediately after the activity that caused the pain. The appliance of warmth is suggested to relax the muscles and promote blood flow and a healing environment, no quite 15-20 minutes at a time.
Stretching is recommended, starting with stretching the hamstrings and progressing over time. In addition, particular attention should be paid to stretching the hamstrings twice each day to alleviate tension within the lower back. The exercise program should be controlled and gradually increased over time.
- Manuals handling
Manual manipulation by properly trained osteopaths, physical therapists, and other healthcare professionals can help reduce pain by mobilizing the painful joint from dysfunction.
With age the lordotic curve or lumbar lordosis is accentuated, thus being essential to do physiotherapy, daily exercise, stretching, and take good care of postural hygiene so that the injury slows its evolution.
At Resolution, a clinic specialized in spinal treatment, we also recommend stopping contact and impact sports and resting from any activity that causes pain. Once the pain has disappeared, you can resume sports activity little by little.