I had back pain off and on for about 14 years, doctors usually thought I was too young for such intense pain, one doctor accused me of being a pill seeker. I was so frustrated I reported him to the local hospital administrator. I also fired a couple doctors because they acted as if I was making stuff up. They acted as if giving me a CT scan or MRI was coming out of their pocket- so it never got ordered until years later and one day I had went to the doctor got X-rays and was told I had bilateral pars fracture in my back known as Spondylolysis later developed into Spondylolisthesis.

Medical Definition – A pars interarticularis defect is a unilateral or bilateral fracture involving the pars interarticularis of the posterior vertebral arch. This injury occurs almost exclusively in the lower lumbar region, most often at L5. This activity highlights the interprofessional management of this condition.

What is spondylolysis?

Spondylolysis. Pars defect. Stress fracture. These three terms are used interchangeably, all referring to the same condition. Spondylolysis is a stress fracture through the pars interarticularis of the lumbar vertebrae. The pars interarticularis is a thin bone segment joining two vertebrae. It is the most likely area to be affected by repetitive stress. This condition is fairly common and is found in one out of every 20 people.

What are the symptoms of spondylolysis?

Spondylolysis doesn’t always have symptoms. When it does, the only symptom is usually back pain. The pain often gets worse with activity and sport, and is more notable when bending backward. Generally, the pain doesn’t interfere with everyday activities. If it persists, it is recommended to seek medical attention.

What are the risk factors for spondylolysis?

Being human and walking upright is the most basic risk factor for spondylolysis. The natural inward curvature of the lower back puts stress on the pars interarticularis. Certain sports that involve excessive or repetitive bending backward may increase the risk of spondylolysis. Examples include gymnastics, football and soccer. Young athletes may sometimes develop spondylolysis as a result of overuse and hyperextension of the lower back. Genetics could also be a risk factor for some people.;

Spondylolysis Diagnosis

If you have long-lasting, localized low-back pain, it could be due to spondylolysis. An X-ray is sometimes sufficient to defect a stress fracture. However, if pain persists despite rest and physical therapy, additional imaging may be necessary. Your doctor may need to order an MRI, a CT scan or a nuclear medicine bone scan with SPECT of the lumbar spine for a definitive diagnosis.

Spondylolysis Treatment

Spondylolysis treatment focuses on managing the pain and helping you return to your daily activities. This condition doesn’t typically put you at risk for spinal cord injury or nerve damage.

Depending on the degree of pain, treatment options include:

• Rest/break from sports
• Nonsteroidal anti-inflammatory drugs
• Physical therapy for muscle strengthening and general conditioning
• A lumbar brace

Surgery to repair the fracture is rarely needed, as the pain is expected to fade over time in most cases.

Spondylolisthesis

Spondylolisthesis occurs when one vertebra in the spinal column becomes fractured and the spine slips out of place, usually in the lumbar area. Back pain, numbness in the extremities, or sensory loss can be caused by nerve root compression as a result of the slippage. Related conditions include spondylosis which is arthritis of the spine, and spondylolysis which is a fracture of a vertebra without it coming out of alignment.

What is Spondylolisthesis?

Spondylolisthesis occurs if a vertebra shifts as a result of a widening fracture when the muscles and ligaments holding a vertebra in place become overworked; the vertebral body can then slide forward onto the vertebra below. The forward slip makes the spinal canal smaller, leaving less room for the nerve roots and often causing a pinched nerve. Teenagers sometimes develop a type of spondylolisthesis in which one vertebra slips forward and slides completely off the vertebra below.

Spondylolisthesis can also occur in the cervical spine and may result from a neck injury or rheumatoid arthritis. Cervical spondylolisthesis usually causes neck pain and stiffness.

What Causes Spondylolisthesis?

Spondylolisthesis can be caused by degeneration, trauma, or congenital defects. It most commonly occurs in the lowest lumbar vertebra on the bony ring formed by the pedicle and lamina bones, which protects the spinal cord and spinal nerves. The bone is weakest in the area, pars interarticularis, which joins the upper and lower joints. At first, the body can heal the damage produced by strain on the bone. However, if repeated strains occur faster than the body can respond, the bone will eventually fracture. This pars defect or fracture is called spondylolisthesis.

When you’re diagnosed with spondylolisthesis might be wondering what to expect.

To help you understand your condition and how to manage it effectively, here’s an overview of what you should know about living with spondylolisthesis.

Spondylolisthesis normally affects the vertebrae in your lower back, but it can also affect the mid to upper back or the neck as well.

Spondylolisthesis is not always easy to diagnose. As with many spinal conditions, one of the most common spondylolisthesis symptoms is lower back pain which can extend into the buttocks or thighs. Other spondylolisthesis symptoms you may notice include:
• Back muscle stiffness, tightness, or spasms
• Difficulty standing or walking for long periods of time
• Pain which radiates down one or both legs
• Back or leg pain when bending over
• Numbness, weakness, or tingling in the foot
• Tight hamstrings
When pain spreads down the leg, or there’s numbness, weakness, or tingling in the leg or foot, this could indicate nerve compression or irritation caused by the slipped bone.

You might also experience numbness, tingling, or pins and needles down to your foot if the vertebrae is pinching a nerve. Tight hamstrings
When pain spreads down the leg, or there’s numbness, weakness, or tingling in the leg or foot, this could indicate nerve compression or irritation caused by the slipped bone.

When you’re living with spondylolisthesis, it’s important to avoid movements which make the condition worse. Movements which may aggravate spondylolisthesis include:

• Repeated bending, extending, or twisting motions
• Sitting slumped or hunched over 
• Lifting objects with a rounded back  

The key is to stay as active as possible while avoiding movements which make your individual condition worse. That’s why it’s so important to consult a specialist; they can help you stay mobile without aggravating your spondylolisthesis.

Spondylolisthesis Exercises to Avoid 

Typically, you’ll want to avoid exercises which require twisting, bending, or flexing of the spine. Sports and movements to avoid include:

• Certain pilates and yoga poses e.g. upward dog, cobra
• Gymnastics
• Contact sports
• Weightlifting 
• Wrestling

You should also avoid any exercises that cause pain. Your specialist can explain what activities are safe for you based on your condition and existing medical history.

Is Walking Good for Spondylolisthesis?

Walking helps to keep your muscles and joints mobile without placing extra pressure on your lower back, so it’s often recommended for spondylolisthesis patients. Start with daily 5 or 10-minute walks, keeping your spine neutral and your shoulders relaxed.

Just remember to pace yourself and stop or slow down if walking aggravates your symptoms. 

How to Sit With Spondylolisthesis

When you’re living with spondylolisthesis, it’s important to sit with good posture.

• Sit with a neutral spine. Don’t slouch. 
• Keep your lower back supported by using a pillow or sitting flush against the chair.
• Sit with your feet flat on the ground rather than sitting cross-legged or hunched over. 

A physical therapist can show you how to sit with good posture if you’re unsure.

Sitting improperly when you have spondylolisthesis can aggravate the pain and exacerbate the condition. Here are a few tips to help you sit with spondylolisthesis:

1. Keep Your Spine in a Neutral Position

Like many musculoskeletal issues, a key factor in spondylolisthesis is posture. Poor posture has a tendency to aggravate many different spinal conditions including spondylolisthesis. In contrast, correcting your posture and maintaining such can help ease the pain and other difficulties spondylolisthesis can cause.

You want to support and maintain your spine’s natural ‘S’ shape by sitting up straight, keeping your feet flat on the floor, and your hips tilted forward. Sitting consistently with correct posture will go a long way in alleviating your pain.

2. Develop a Physical Therapy/Exercise Routine

One way of treating Spondylolisthesis is through physical therapy and exercise. As noted above, correct posture is critical when dealing with musculoskeletal issues like spondylolisthesis.

In light of that, many physical therapists will prescribe a set of PT exercises for their patients to do that will strengthen muscles that surround and support the spine in key areas. Strengthening such muscles will, over time, reduce slouching and improve the overall posture of the individual in question.

3. Wear a Back Brace for Support

Another option for a patient suffering from spondylolisthesis is to wear a back brace to keep your spine in proper posture while you are sitting. This may be particularly necessary if you, like many other people, work behind a desk and, so, find yourself sitting for much of the day.

A back brace will physically prevent you from slouching or slumping and thereby distorting the natural ‘S’ shape of your spine. However, realize that the more your muscles rely on the brace, the less work they have to do to keep your spine aligned properly. In time, this might lead to weakening of those muscles unless you take other steps (like exercises) to strengthen them.

4. Use Ergonomic Devices To Help You Sit Properly

Advances in science have given us a better understanding of the human body, the musculoskeletal system, posture, and the spine. As a result a number of ergonomic devices have been developed to assist patients with spondylolisthesis or other ailments to keep their spines in a neutral position while sitting. These devices include:

• Ergonomic Chairs: these chairs are specially designed for providing comfort while, at the same time, keeping you in correct posture. Normally, ergonomic chairs provide special support to your bottom, and your back.
• Ergonomic Cushions: these cushions include lumbar cushions and ergonomic wedge cushions. Although these cushions do not support the whole of the back, they provide specialized support to your bottom that “encourages” a natural, neutral, alignment of the spine.

Health Disclaimer

This blog provides general information and discussions about health and related subjects. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical treatment. Never disregard professional medical advice or delay in seeking it because of something that have read on this blog or in any linked materials. If you think you may have a medical emergency, call your doctor or emergency services immediately.