Lumbar spine

Spondylolysis and spondylolisthesis

What is it ?

These are two very specific terms. Spondylolysis refers to a “rupture” (lysis) of a bone bridge in the posterior arch of a lumbar vertebra. Most often, this lysis appears in teenagers practicing an intense and regular sports activity. Sports at risk are: football, basketball, rowing, artistic gymnastics, etc. Lysis is a kind of fatigue fracture caused by repeated movements, in the context of growth and a particular anatomy of the spine. Very often, teenagers are asymptomatic and the pain is triggered rather in adulthood when the disc begins to degenerate (normal aging). However, pain can occur during adolescence, forcing the child to temporarily interrupt sports.

Spondylolisthesis refers to a “sliding” (listhesis), in general progressive and slow, of a lumbar vertebra (spondylos) in relation to the one below. This shift can be appear in the context of isthmic lysis (see above) and is called in this case isthmic spondylolisthesis, but most commonly, it occurs in adults whose discs and facet joints are worn out. It is then called “degenerative spondylolisthesis”, whose peculiarity is that it also causes a narrowing of the lumbar canal, and potentially a neurogenic claudication (see lumbar spinal stenosis).

Clinical presentation

Isthmic spondylolisthesis is very often asymptomatic in adolescents. In adults, it can cause lower back pain and radicular pain (sciatica or cruralgia).

Degenerative spondylolisthesis may be asymptomatic, but may also cause low back pain and / or neurogenic claudication.

When to consult a specialist?

The symptomatic adolescent will rapidly undergo a lumbar MRI and a follow-up with a rehabilitation doctor most often, surgical treatment being rare.

In adults, the spine surgeon will be consulted if there is disabling pain (low back pain or sciatica) or a neurologic deficit (loss of strength, neurogenic claudication).

Non surgical treatment

It will depend on the type of symptoms. Low back pain can be treated with a brace, medication, physiotherapy-strengthening, etc., similar to “non specific” low back pain. Neurologic pain in adults will be difficult to treat non-surgically due to the mechanical cause of the pain.

Surgical treatment

It will be offered for disabling low back pain or sciatic pain (neurological pain). In this pathology of mechanical origin (isthmic or degenerative spondylolisthesis ), very often it will be necessary to stabilize the spine with implants (screws and rods, cages). This decision is also based on the analysis of the sagittal balance which allows a personalized approach for each patient.

Postoperative follow-up

It depends on the extent of the surgery. In general, patients remain hospitalized for a few days. Rehabilitation begins the day after the operation, often at first with a walking frame, then quickly independently. For the first 6 to 8 weeks, patients experience pain from the surgery, but which is controlled by pain killers. They are encouraged to walk as much as possible and resume their daily life activities within the limits of their pain, without carrying loads. Depending on the type of surgery, it takes between 3 and 6 months to fully recover.

Risks and complications

They depend on the surgical technique chosen. There are general risks associated with any surgery. The specific risks such as serious neurological complication are very low (<1%). The infectious risk is 2 to 3%. All this is reviewed in a non-exhaustive manner with the surgeon during a pre-operative interview.