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What is a “Spondylo”?

By: Dale Buchberger, PT, DC, CSCS, DACBSP

There area many causes of lower back pain. In teenagers and young adults lower back pain may be caused by something commonly referred to as a “spondylo”. This term has been commonly used as an abbreviation for either a spondylolysis and/or a spondylolisthesis.

Spondylolysis is a defect in an area of the vertebrae referred to as the pars interarticularis, the thin piece of bone that connects the upper and lower segments of the spinal (or facet) joints. This defect can be the result of a congenital defect, a stress fracture from repetitive movement or a one time traumatic incident, usually a hyperextension injury. The word spondylolysis comes from the Greek words spondylos, which means spine or vertebra, and lysis, which means a break or loosening.

People with spondylolysis are generally asymptomatic and don’t realize they have the condition. When symptoms do occur, lower back pain is the most common. The pain is generally worse with vigorous exercise or activity. Symptoms often appear during the teenage growth spurt. The typical age of a person diagnosed with spondylolysis is 15 to 16 years.

Spondylolysis affects about 3 percent to 7 percent of Americans. It is seen more often in males than in females. The condition is a common cause of low back pain in children and the most likely cause of low back pain in people under the age of 26. Spondylolysis is more common in children and teens participating in sports that place a lot of stress on the lower back or cause a constant over-stretching (hyperextending) of the spine, such as gymnastics, weightlifting (especially heavy squatting), and football.

Spondylolisthesis (spon + dee + lo + lis + thee + sis) is a condition in which one of the bones of the spine (vertebrae) slips forward on the vertebra below it. As one vertebra slips forward on another it causes the muscles, tendons and ligaments of the back to stretch, eventually resulting in nerve compression and associated pain.

The word spondylolisthesis comes from the Greek words spondylos, which means “spine” or “vertebra,” and listhesis, which means “to slip or slide.” There are three common forms of spondylolisthesis. The first is known as congenital spondylolisthesis. Congenital means, “present at birth.” Congenital spondylolisthesis is the result of an abnormal arrangement of the vertebrae that puts them at greater risk for slipping. The second is referred to as isthmic spondylolisthesis. This type occurs as the result of spondylolysis, a condition that leads to small stress fractures (breaks) in the vertebrae. In some cases, the fractures weaken the bone so much that it slips forward. The third type is degenerative spondylolisthesis. This is actually the most common form of the disorder. With aging, the discs between the vertebrae begin to lose water, becoming rigid and unable to resist movement by the vertebrae.

Spondylolisthesis is the most common cause of back pain in the teenage population. Symptoms of spondylolisthesis often begin during the teenage growth spurt. Approximately 5%-6% of males and 2%-3% of females will have a spondylolisthesis. Degenerative spondylolisthesis occurs most often after age 40.

As with spondylolysis, people with spondylolisthesis are generally asymptomatic and don’t realize they have the condition. The pain pattern is similar to spondylolysis, usually spreading across the lower back, feeling similar to a muscle strain. The patient may also experience sciatic type symptoms with pain radiating down the leg to the foot.

There are several different grades of spondylolisthesis. A radiologist determines the degree of slippage on spinal X-rays. The slippage is graded I through V:

Grade I: 1 percent to 25 percent slip Grade II: 26 percent to 50 percent slip Grade III: 51 percent to 75 percent slip Grade IV: 76 percent to 100 percent slip Grade V: The vertebrae is positioned in front of the vertebrae below <{> Generally, the symptoms of all grades can be treated conservatively. Surgical consultation or intervention is considered when symptoms fail to respond to conservative treatment such as physical therapy. If neurological symptoms begin to progress and function is being lost, surgical consultation and intervention are considered earlier in the management process.

Spondylolysis and spondylolisthesis are commonly seen together but can also be seen separately. If you have an athletically active teen complaining of lower back pain, they should see a healthcare provider to be assessed. Having an X-ray to check for a “spondylo” is an important step to getting an accurate diagnosis. Once it is assessed consider physical therapy as a conservative option for treatment. Remember, it’s your right as the patient to choose which physical therapist you see!

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