Understanding spondylolysis and why the younger athletic population is usually the most susceptible can help you understand the different options for managing it.
You can define spondylolysis as a bone defect that happens within the interarticularis of the vertebral arch. It may present itself as a fracture or a weakness. Most spondylolisthesis defects will be seen with level L5, which accounts for around 85 to 95 percent of cases, and level L4 as the second most commonly affected. Rarely do the upper levels of the lumbar spine suffer from this condition.
What is Spondylolisthesis?
This condition occurs when one of your vertebrae shifts forward on top of another. The slip will normally happen at the L5 level, and it will cause the vertebrae to be out of alignment with the rest of your spinal vertebrae. Most often, it happens because of a bilateral spondylolisthesis, which has been reported in 50 to 81 percent of the cases. Sometimes it occurs because of trauma, birth defect, or degeneration.
Grading the Slip
The degree of the slip can be graded through what’s known as the Meyerding scale. If you have a first-degree injury, it will involve a zero to 25 percent slippage in diameter. For second-degree slippages, it will be anywhere from 25 percent to 50 percent. Third-degree slippage will be anywhere from 50 percent to 75 percent. A fourth grade slip will be a 76 percent to 100 percent displacement of the vertebrae. Finally, a fifth grade slip is classified when the vertebrae slips completely off.
The Etiology and Epidemiology
Experts estimate that spondylolysis exists in between six to eight percent of the general population. In particular, that number increases in athletes who play sports because of repetitive hyperextension and rotation with the lumbar spine. If you had to single out a particular group that suffers from this condition the most, it would likely be athletes because of their tendency to overextend the body. In addition, researchers have found how cricket bowlers have an increased risk for the condition.
Cause of Spondylolisthesis
The cause of Spondylolisthesis remains unclear. Some people have described this as a hereditary condition that happens because of repeated stress to the lumbar spine. For younger athletes, the higher frequency of the condition could be explained due to their spine’s continued growth. They often get exposed to what’s known as hyperextension and the rotation of the lumbar spine. This leaves them susceptible to the condition, but it also leaves them open to injury as well.
The Clinical Presentation
In most cases with spondylolisthesis, the cases are asymptomatic. What does that mean? It means the condition doesn’t show any warning symptoms that could have indicated how a person suffered from it. Experts conducted a subjective assessment, and they learn how the onset of the pain can either be acute, or it can gradually build up to be worse. The assessment also learned that many of the people suffering from spondylolisthesis had trauma to the area, which may have caused the growing problem.
In particular, athletes between the ages of 15 and 16 were the most likely to be diagnosed with this condition. The problem could grow worse for anyone who repeats an intensive athletic activity.
What Symptoms Might be Present?
Some of the symptoms that you might encounter include:
- A dull ache or a sharp pain from movement.
- Focal low back pain.
- The pain might radiate into the proximal lower limbs, or it could radiate into the buttock.
- Limits ADLs
- Unbearable pain
- The symptoms grow worse with stressful events
- Tightness in the hamstrings
- Rest will usually ease the symptoms
How Do Doctors Diagnose Spondylolisthesis?
While there’s no ideal option for diagnosing spondylolisthesis, doctors have identified a variety of methods that are all reliable choices. Early diagnosis is said to be one of the most important aspects to healing spondylolisthesis. There are a variety of imaging tools like x-rays that you might use as a way of diagnosis it. For younger athletes, they will often be given bone scans as a way to treat it.
With CT scans, numerous x-rays will be taken at different cross sections of the body, and this will create a virtual slice. Next, a computer will combine the images so that you can scroll through the body part. In some cases, CT scans have been seen as more sensitive than what you’d get with a regular radiograph.
This x-ray will be used on the coronal, axial or sagittal plane. The nuclear medicine gets injected into the patient in low doses of a radioactive gamma ray. It will be used to attach to the body’s different cells. This can be used as a method of producing multiple 2D images, and it can later be used for creating 3D imaging onto the computer.
An MRI machine makes use out of a magnetic field, and it uses radio waves as a method for producing images in the body. The magnets will help to cause the proton cells within the body to line up even while the radio waves knock the protons out of the way. MRI scans have been popular as the alternative to CT scans and SPECT scans because of how it has non-ionising properties.
Based on a report from the British Journal of Sports, an estimated 47 percent of young athletes that reported lower back pain were diagnosed with spondylolisthesis. Why are athletes more predisposed to this condition? In bowling, the action of bowling in cricket often involved a rotation and the side flexion of the spine, which happens at higher speeds. This could be one of the biggest reasons that people who participated in it had a higher tendency of developing this condition.
In the earliest stages of this condition, treatment will usually involve rest, which can be for up to eight months as a way of addressing the problem. After that point, it becomes vital to take other factors into account like core stability, muscle imbalance and pelvic control. Instead of the activities that may have triggered it, cardiovascular activities are often a good replacement. You might take on swimming or cycling as long as you remain symptom-free.
To learn more about spondylolisthesis and treatment options, visit the Focus Physiotherapy website.