Spondylolisthesis in Children – Adolescents
What is spondylolisthesis?
Spondylolisthesis is generally defined as an anterior or posterior slipping or displacement of one vertebra on another. Most often, this displacement occurs following a break or fracture. If you have spondylolisthesis, one of your vertebrae moves more than it should and slides out of its usual spot and onto the vertebra below it. This can put pressure on nerves around your spine and cause pain in the lower back and lower limbs.
Spondylolisthesis is divided into five types:
Spondylolisthesis is generally defined as an anterior or posterior slipping or displacement of one vertebra on another. Most often, this displacement occurs following a break or fracture. If you have spondylolisthesis, one of your vertebrae moves more than it should and slides out of its usual spot and onto the vertebra below it. This can put pressure on nerves around your spine and cause pain in the lower back and lower limbs.
Isthmic spondylolisthesis
Isthmic spondylolisthesis happens when the bone that connects two vertebrae together (the pars interarticularis) breaks and can’t hold its usual alignment. That fractured vertebra then slips out of place. The cause of isthmic spondylolisthesis is undetermined, but a possible etiology includes microtrauma or fracture in adolescence related to sports such as wrestling, football, and gymnastics, where repeated lumbar extension occurs.
Degenerative spondylolisthesis
Degenerative spondylolisthesis is the result of the progression from degenerative changes in the intervertebral disc and facet joints that lead to destabilizing one or more vertebral segments. It is characterized by the anterior sliding of the vertebral body secondary to the sagittalization.
Dysplastic spondylolisthesis
Dysplastic spondylolisthesis that is also known as congenital spondylolisthesis is caused when your vertebrae are aligned incorrectly due to a birth defect. In dysplastic spondylolisthesis, the defective pars interarticularis can be only on one side or on both sides. In simple words, when the defect weakens the bones to an extent that it cannot maintain its alignment in the spine and starts shifting or slipping out of place. Dysplastic spondylolisthesis commonly occurs when L5 slips over the S1.
Traumatic spondylolisthesis
This type is caused by a fracture of the pedicle, lamina or facet joints as a result of direct trauma or injury to the vertebrae creating instability.
Pathological spondylolisthesis
It is the rarest type of Spondylolisthesis, which is mainly caused by metabolic diseases of ligaments and bones or, more rarely, by osteolytic lesions (tumors).
How will I know if my child has Spondylolisthesis?
The most common symptoms are:
- Lower back pain
- Thigh and buttock pain
- Muscle stiffness in the lower back
- Tenderness in the lower back
- Tight muscles (particularly the hamstrings)
- Pain that radiates from the lower back down the legs
- Weakness in the legs or difficulty walking
- Pain, numbness and tingling in the lower extremities
- Extreme lordosis
Is the early diagnosis of spondylolisthesis important in children and adolescents?
It is very important to make an early and correct diagnosis in order to apply the appropriate treatment so as to reduce the pain caused by the nerve pressure so that the child to be functional and participate in every activity of his/her daily life.
If my child detects the symptoms what can I do?
If you notice any symptoms, it is advisable to call your pediatrician. If he/she considers them worrisome, he/she will refer you to a specialized Spine Surgeon, who, after an evaluation and a series of tests, will indicate the appropriate treatment for each case individually.
How is spondylolisthesis diagnosed in children and adolescents?
At first, the doctor will ask about the child’s activities and take a full medical history. An X-ray (test that creates images of bones) is usually the only test that is needed. The problem often can be seen on an X-ray. Depending on the case, other imaging tests (such as an MRI or a CT scan) may be done to get more detailed information about your child’s spine. In younger children, a spondylolisthesis is often monitored with repeated X-rays.
What is the appropriate treatment for Spondylolisthesis in children - teenagers?
At first, the doctor will ask about the child’s activities and take a full medical history. An X-ray (test that creates images of bones) is usually the only test that is needed. The problem often can be seen on an X-ray. Depending on the case, other imaging tests (such as an MRI or a CT scan) may be done to get more detailed information about your child’s spine. In younger children, a spondylolisthesis is often monitored with repeated X-rays.
Most children with spondylolisthesis get better by resting and doing exercises designed to stretch and strengthen the back.
Spondylolisthesis, depending on the case, may also need appropriate treatment such as:
Physical Therapy
Physical therapy plays a vital role in enhancing and maintaining optimal physical function, mobility, and pain-free living. The benefits of physical therapy are numerous and can significantly improve a person’s quality of life. The aim of physical therapy is to relieve pain, help you move better or strengthen weakened muscles.
Injections
Injections are a common way of treating the pain from a spondylolisthesis, especially in adults. They may help control the pain enough to keep you functional. They can be into the joints in your back or around the nerve roots. The injections use a combination of steroids and local anesthetic. They can be repeated if necessary. The main down side for injections is that they don’t work for everyone and if they do work they can wear off. The upside of injections is that they are low risk and relatively easy to have done.
Surgery
The doctor will assess each case individually and suggest the appropriate treatment. In case surgery is considered necessary, your Spine Surgeon will take the medical history and inform you about this procedure. Then he/she will talk to you about the risks and benefits of this type of operation and the post-operative stage. The most suitable surgical treatment for children with spondylolisthesis is posterolateral fusion with a decompression. It is an operation that relieves pressure on nerve roots as well as fuses part of the spine through a cut on your back. It involves rods and screws being placed in your spine. The rods and screws help reduce the amount of slippage and help stop it worsening.
