Isthmic spondylolisthesis is a condition where a small bone in the spine fractures, causing vertebrae to become unstable and slide forward. It is most common in children and adolescents and can cause physical symptoms. Treatment includes rest, medication, physiotherapy, and surgery as a last resort.
The pars interarticularis is a small bone that connects one vertebra to another in the spine. Sometimes this thin piece of bone can sustain a fracture, known as spondylolysis. When this occurs, the affected vertebrae can become unstable and one can slide forward over the other. This condition is known as isthmic spondylolisthesis.
Isthmic spondylolisthesis occurs most frequently in children and adolescents. It occurs most commonly in the lower back, lower lumbar vertebrae. The initial spondylolysis fracture is typically caused by repetitive stress to the pars interarticularis, which is not particularly strong bone.
There are four grades of isthmic spondylolisthesis based on how well the upper vertebrae slide over each other. Grade one is relatively mild, 25% or less, and grade two is 25% to 50%; most patients fall into one of these two categories. More severe grade three (50% to 75% slip) and grade four (more than 75%) cases are less common and will cause very noticeable physical symptoms, including severe undulation, an abdomen that appears distended towards the outside and possibly difficulty walking due to tight hamstrings. In the most extreme cases, one vertebra can slip completely off the other; the condition is then referred to as spondyloptosis and is also known as fifth degree isthmic spondylolisthesis.
When isthmic spondylolisthesis occurs, particularly the lower grades, it is often painless and causes no symptoms. Many people will never have problems with the condition, or the symptoms may be very mild. Those who develop back or leg pain often do so in adulthood, as the discs between the vertebrae begin to break from the force of the unsupported bones pressing on them. Higher grade slips, especially at levels three and four, can be more problematic due to the effect they have on posture and movement.
Treatment for isthmic spondylolisthesis, if needed, is typically approached conservatively initially. Rest, oral steroids, and pain medications such as NSAIDs are often used, and in cases where the pain is severe, steroid injections at the site may help. Physiotherapy and stretching exercises may also be prescribed, to strengthen the back and relax the hamstrings. Patients who do not find relief from these less invasive techniques may consider surgery. The main form of surgical correction of isthmic spondylolisthesis is lumbar spinal fusion; this is usually very effective in correcting the problem, but should be considered a last resort as this is an important procedure.
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