Forward slippage of a lumbar vertebra on the vertebra below it.

Causes, incidence, and risk factors

The spine is divided into 5 anatomical sections: cervical (neck), thoracic (thorax or rib cage), lumbar (the lower back from bottom of the thoracic spine to the top of pelvis), sacral (pelvis) and coccygeal (tail). Spondylolisthesis is a condition in which a vertebra slips forward on the vertebra below it. In children this normally occurs between the fifth lumbar vertebra and the first sacral vertebra and is often due to a congenital malformation of that region of the spine. In adults, the most common cause is degenerative disease (like arthritis) and the slip usually occurs between the fourth and fifth lumbar vertebrae. Other causes of spondylolisthesis include stress fractures (caused by repetitive hyper-extension of the back, commonly seen in gymnasts), and traumatic fractures. Spondylolisthesis may occasionally be associated with bone diseases. Spondylolisthesis may vary from mild to severe. It is associated with and can produce increased lordosis (abnormal anterior convexity of the spine or swayback). Symptoms may include lower back pain and pain in the thighs and buttocks, stiffness, muscle tightness, and tenderness in the slipped area. Neurologic damage (leg weakness or changes in sensation) may result from pressure on nerve roots and may cause pain radiating down the legs.

Signs and tests

Treatment

Treatment varies depending on the severity of the spondylolisthesis. Most patients require only strengthening and stretching exercises combined with activity modification (avoiding hyperextension of the back and contact sports). Some practitioners also use a rigid brace. For cases with severe pain not responding to therapy or if the slip is severe or there are neurologic changes, the slipping vertebra will be surgically fused. This surgery has a higher incidence of nerve injury than do most other spinal fusion surgeries. Use of a brace or body cast may be part of treatment after surgical correction of the defect.

Expectations (prognosis)

Conservative therapy for mild spondylolisthesis is successful in about 80% of cases. When necessary, surgery produces satisfactory results in 85 to 90% of people with severe, painful spondylolisthesis.

Complications

Calling your health care provider

Call your health care provider if your child's back appears to curve excessively, if the child complains of back pain or stiffness, or pain in the back , thighs, and buttocks.

Prevention

People with marked lordosis should avoid back hyperextension (leaning way back), weight lifting, and contact sports. Lower back pain , although common in preadolescent and adolescent children, should be evaluated especially in the presence of marked lordosis.