Bone, Joint and Muscle Conditions

Spondylolysis and Spondylolisthesis

What is spondylolysis and spondylolisthesis?

Spondylolysis (spon-dee-low-LYE-sis) is a long word that means spine defect. Children with spondylolysis have a problem in the bones (vertebrae) of their lower back.

Spondylolysis may lead to spondylolisthesis (spon-dee-low-lis-THEE-sis). Spondylolisthesis means spine slippage.

  • Doctors think the problem may be due to tiny cracks in the bones (stress fractures). Often too much use causes these cracks to develop over time. Usually this problem is not present when the baby is born (congenital).

  • In a normal backbone, the bones are stacked on top of each other with disks in between them that act as shock absorbers. When one of the bones slides forward off the disk and onto the bone underneath it, it is called spine slippage.

  • These two conditions are the most common causes of ongoing (chronic) back pain in children. As many as 6% of children may have spondylolysis by the time they are 6 years old.

  • Children who take part in sports that require them to arch their backs a lot get stress fractures in the backbone more often than other children. Gymnasts, down linemen in football, volleyball players and swimmers who do the butterfly stroke are most likely to have this problem.

Spondylolysis and Spondylolisthesis at Seattle Children’s

The Spine Program at Seattle Children’s brings together a team of specialists to treat spondylolysis and spondylolisthesis in children, teens and young adults using nonsurgical and surgical methods.

    • The Spine Program team includes doctors, surgeons, physician assistants and nurse practitioners from Orthopedics and Sports Medicine.
    • We offer your child the support of an entire medical center. Based on your child’s needs, we involve specialists from other areas of Seattle Children’s, such as Adolescent Medicine, Neurosurgery, Rehabilitation Medicine, Rheumatology and Pain Medicine.
    • Nonsurgical treatment commonly means physical therapy or a back brace. We have the largest team of physical therapists in the Pacific Northwest who specialize in the care of babies, children, teens and young adults. We also have onsite orthotists to build and fit braces for our young patients.
    • If your child needs surgery, our pediatric orthopedic surgeons have expanded fellowship training in spine problems and a national reputation for excellence in all types of spine surgery.

    • Children and teens are still developing. When we evaluate your child’s spine, design their treatment and provide their care, we carefully consider how growth may affect your child’s spine over time — and how their spine may affect the rest of their development and health.
    • Our experts have the knowledge and training to treat the youngest patients from babies through young adults.
    • We take care to find out what is causing your child’s pain, and we believe that surgery is not necessary for most back problems in children.
    • We have the largest group of board-certified pediatric radiologists in the Northwest. If your child needs imaging that uses radiation, we use the lowest amount possible (PDF) to produce the best image.

    • Before recommending any surgery, we look at your child as a whole person and take into account many factors, including the degree of their spinal problems, the effects on their health, their remaining growth and what results you can expect from treatment.
    • Our surgical spinal cord monitoring team leads the country in developing new techniques for making back surgery safer. We have developed recent advances in spinal cord monitoring and treatment of scoliosis in very young children. Neuromonitoring helps us prevent a spinal cord injury during surgery.
    • We have the technology and expertise to precisely place hardware, such as rods and screws, in your child’s spine, including with CT (computed tomography)–guided surgery.

    • Your child’s team works together not only to plan and provide care for your child, but also to make sure you and your child understand your child’s condition and treatment options.
    • Coordination is easier for you because your team members from the Spine Program work closely with each other and with other specialized programs and clinics your child may need at Seattle Children’s.
    • We support your family with a range of resources, such as Child Life specialists, the Family Resource Center and Guest Services.

Symptoms of Spondylolysis and Spondylolisthesis

Spondylolysis and spondylolisthesis may not cause any obvious symptoms for some children. In others, spondylolysis can cause pain that spreads across the lower back. Pain may be worse when children arch their backs.

  • If the slipping is severe for children with spondylolisthesis, it can stretch the nerves in the lower part of the back. This can lead to:

    • Pain that goes down one or both legs
    • A numb feeling in one or both feet
    • Weakness in your child’s legs
    • Trouble controlling bladder or bowel movements

Diagnosing Spondylolysis and Spondylolisthesis

Slip displacement. Courtesy of 'Fundamentals of Pediatric Orthopedics,' © 2003 Lippincott Williams & Wilkins

Slip displacement

Doctors look first for signs of cracks in the bones of your child’s back. These cracks are called stress fractures. We look for stress fractures first because spine slippage, though rare in children, usually happens to those who have the fractures first.

The doctor will ask your child if the pain is worse when they arch their back. This is a common sign of stress fractures. Most often, these fractures are in the lower part of the backbone.

  • Next, we most likely will take X-rays of your child’s backbone. This helps doctors make sure your child has a stress fracture. If we cannot see the crack clearly on the X-ray, we may ask to do a bone scan.

    If we find a crack in the bone, we will probably take a three-dimensional X-ray called a CT (computed tomography) scan. This will give us an even better look at the fracture and help you and your child’s doctor decide on treatment.

Treating Spondylolysis and Spondylolisthesis

We use both surgical and nonsurgical treatment to treat spondylolysis and spondylolisthesis. Most children do not need surgery.

  • At Seattle Children’s, we offer exercise programs (physical therapy) to strengthen your child’s muscles in the back and belly (abdomen). This helps support the backbone and can help prevent more back pain. We may also ask your child to temporarily stop doing the activity that is causing the injury.

    These steps may be all your child needs to relieve symptoms and heal.

  • For some children, back braces can take the pressure off the lower back and relieve the pain so they can return to sports and school.

    The braces flatten out the normal curve (lordosis) of the lower spine. Your child will wear the brace as they move about during the day. Usually, children wear a brace for 2 to 3 months.

    As the pain decreases, your child can slowly decrease the amount of time they wear the brace. Read about braces and our other orthotics and prosthetics services.

  • If your child’s pain continues after rest and bracing, they might need surgery to fix the fracture or stop the slipping. At Seattle Children’s, we offer two operations to treat these conditions:

    • In one operation, the doctor repairs the bones by placing a metal implant across the fracture and using a bone graft to help healing.
    • In the other operation, doctors join 2 or more bones together (fusion) to make your child’s back more stable. To do this, doctors place screws into the bones of your child’s lower spine and connect them with a bar to hold the spine still. Next, they place a bone graft in the area to help the bones grow together.
    We will discuss each option with you and your child to decide which is likely to work best.

Contact Us

Contact Orthopedics and Sports Medicine at 206-987-2109 for an appointment, a second opinion or more information.

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