Your lower back is called your lumbar spine. It is made up of five bones called lumbar vertebrae. The vertebrae have two major parts, a solid part called the body and a bony ring through which the lower part of the spinal cord and nerves travel. Between the bodies of the vertebrae is shock absorbing material called disks. Part of the ring of each vertebra touches the vertebra above it and the vertebra below it.
Spondylolysis is a condition where there is a break in one or both sides of the ring of a vertebra. Spondylolisthesis is a condition in which a break in the ring allows the body of the vertebra to slip forward. Spondylolysis and spondylolisthesis most commonly occur at the fourth or fifth lumbar vertebrae. These conditions are also called stress fractures.
Spondylolysis and spondylolisthesis result from repetitive extension of the back (bending backward). This weakens the rings of the lumbar vertebrae, eventually leading to a break (fracture) in a ring. Less commonly, these conditions may result from an injury to the back. Some people may be born with weak vertebral rings.
Gymnasts, dancers, and football players are most commonly diagnosed with these conditions.
You may have low back pain or spasms, or you may have no symptoms at all. You may have pain all the time or only from time to time. Spondylolysis or spondylolisthesis usually do not damage the nerves.
Your healthcare provider will examine your back and look for tenderness along your vertebrae or spasm in the muscles next to your vertebrae. You will have an X-ray to check for a break in the ring of a vertebra or slippage of a vertebra. You may have a bone scan, CT scan, or an MRI.
If the break is new and your provider thinks that the bones can heal without surgery, you may need to wear a brace for 1 to 3 months. Severe cases of spondylolisthesis may require surgery.
To treat this condition:
Everyone recovers from an injury at a different rate. Return to your activities depends on how soon your back recovers, not by how many days or weeks it has been since you started having symptoms. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal is to return to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.
It is important that you fully recover from your back pain before you return to any strenuous activity. You must be able to have the same range of motion that you had before your injury. You must be able to walk and twist without pain.
You can best prevent these conditions by having strong back and abdominal muscles and by not being overweight. To help prevent these injuries, do back exercises and avoid activities that force the back to extend, such as tackling in football.
