Spondylolisthesis, Pars Defect & Stress fracture

spi-common-spondylolysis

The term spondylolisthesis refers to the slipping of one vertebra forward on another. Spondylolisthesis predominately occurs around the lumbo-sacral region and is a result of damage to the back portion of the vertebra. The back portion of the vertebra aids in stability of the spinal segment but when damaged, may cause the anterior slipping of the vertebra. A pars defect is the name given to a stress fracture of the pars interarticularis which is located in the back portion of the vertebra. Commonly a pars defect in the lumbar spine results in spondylolisthesis, but the severity and type of the anterior slippage is the determining factor in the stability of the involved vertebra. Forward slippage is due to activity level not gender. There are many forms of spondylolisthesis, but the most common two types are isthmic and degenerative. Isthmic predominately occurs in the young children which are over 5 years old, whereas degenerative is evident in the older/elderly population.

Spondylolisthesis/ pars defect have been shown to be caused by a rapid increase in pressure on the back portion of the vertebra during repetitive movements that involve arching and twisting of the lower back. Any activities which involve loading of the back vertebral structures have an increase risk of developing a pars defect. Some of these activities include gymnastics, weightlifting, bowling in cricket, dancing, rowing, tennis and any throwing activities.

Signs and Symptoms:

  • Most spondylolithesis are asymptomatic but low back pain can develop during extension movements.
  • Low back pain that gets worse with daily activity and increases in severity by the evenings.
  • Patients may present with giving way or catching in the back upon rising from a forward position.
  • Hyperlordosis of the lumbar spine with hamstring tension and prominent gluteal musculature.
  • In degenerative cases, can cause symptoms of canal stenosis.

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