Managing Spondylolisthesis or Vertebral Slippage, a Cause of Low Back Pain
The younger the active patient who has prolonged, localized back pain near the midline, the more likely he or she has spondylolisthesis or vertebral slippage. I am a parent of two children that I diagnosed with spondylolisthesis and treated. First, a careful examination with appropriate x-rays is critical because of the high incident of structural vertebral problems associated with children’s low-back pain. Conservative therapy of relative rest, stretching and chiropractic techniques can prove often very successful for spondylolisthesis or vertebral slippage. Acupuncture has also been proven to be an asset when treating spondylolisthesis or vertebral slippage. The patients’ back pain can be difficult for the primary care physician to diagnose because of the ambiguous character of the symptoms. For children and adolescents, the longer the patient has had untreated back pain, the longer it takes the injury to heal.
Spondylolisthesis or Vertebral Slippage Causes
Spondylolisthesis or vertebral slippage is largely age dependent and may be related to shear stress injuries to the spine. Years ago it was suggested that spondylolithesis was a congenital nature because so many pars defects were found in asymptomatic children. Looking at spondylolysis (no slippage) the prevalence in children between ages 5 ½ and 6 ½ jumps to about 5% and almost all have no pain signaling this condition. Most young children 5 to 9 years of age are likely to be asymptomatic whereas those that are between 10 to 15 years of age tend to have painful symptoms. From ages 16 to 35 there is an increase incidence of having a herniated disc and in older patients degenerated disc disease, which can cause persistent low-back pain.
Overuse caused by repetitive motion is usually the culprit in “pars” injuries with spondylolisthesis or vertebral slippage. Spondylolisthesis or vertebral slippage is graded in 5 catagories:
- Grade 1 is 0–25%
- Grade 2 is 25–50%
- Grade 3 is 50–75%
- Grade 4 is 75–100%
- Over 100% is when the vertebra completely falls off the supporting vertebra.
Spondylolisthesis or Vertebral Slippage Eval and Treatment
On evaluation for spondylolisthesis or vertebral slippage, the patient usually presents with one-sided low-back pain around the belt line and is exacerbated by the characteristic movements usually extension and rotation of his or her sport. The physical exam isusually positive for near-midline pain that is localized with “one-finger” accuracy by the athlete and examining doctor. A positive one-legged hyperextension test strongly supports the diagnosis. There is a wide range of treatment options for spondylolisthesis or vertebral slippage. Common ground includes reducing or stopping of offending activities, strengthening the core muscles of the back and stretching the hamstrings and gluteal muscles. Chiropractic care has shown remarkable results when including rehabilitative techniques. Based on clinical experience most experts recommend a treatment plan that may take from 6 weeks to 6 months. For more information please contact our office for an appointment.
This article on spondylolisthesis or vertebral slippage is informational and not to be used to diagnose or treat any medical condition