The low-back pain in most people has mechanical causes, which include lumbosacral sprain/strain, degenerative disc disease, spondylolisthesis, spinal stenosis and fracture. Here only mechanical low-back pain is considered. Mechanical low-back pain is also called regional low-back pain, which may be local pain or pain radiating to one or both legs (sciatica). It is characteristic for mechanical low-back pain to occur episodically, and in most cases the natural course is favourable. In about half of acute cases low-back pain subsides in two weeks, and in about 90% within two months. About every tenth case is estimated to become chronic, and it is this group of low-back pain patients that accounts for the major proportion of the costs due to low-back disorders.
Interpretation of more recent imaging techniques in relation to disc pathology has not been completely established. For example, degenerated discs on magnetic resonance imaging (MRI) give an altered signal from that seen for "normal" discs. However, the correlation between a disc of "degenerate" appearance on MRI and clinical symptoms is poor, with 45% of MRI-degenerate discs being asymptomatic and 37% of patients with low-back pain having normal MRI of the spine.
In more severe cases, a gap may be seen, or be palpable, at the level of the spondylolisthesis, and may be increased when the patient is moved into extension.
On the other hand, should the spondylolisthesis be at fault, the aims of treatment would be to decrease symptoms, stabilise the spine and control the degree of lordosis.
The spondylolisthetic slip is defined as grades 1 - 4, with grade 1 being defined as a displacement forward by 1/4 of the antero-posterior diameter, grade 2 as 2/4 (or 1/2), grade 3 as 3/4 and grade 4 as 4/4, or full anterior displacement.
When spondylolysis and spondylolisthesis do cause pain, you may experience low back pain, stiffness, and muscle spasms. You may also have sciatica (pain radiating down one or both legs), or numbness, though this is not common. Leg pain will usually be worse when you stand or walk.
Spondylolisthesis is most often caused by spondylolysis. The cause of spondylolysis is not as clearly defined. Most believe it is due to a genetic weakness of the pars interarticularis. Both spondylolysis and spondylolisthesis can be present at birth or occur through injury. Repeated stress fractures caused by hyperextension of the back (as in gymnastics and football) and traumatic fractures are also causes. The most common cause in adults is degenerative arthritis.
Those who play sports, especially gymnasts and football players, are more likely to have spondylolisthesis. The condition most often affects people over 40 years of age. About 5% of Americans have this structural deficiency and don't know it. Just because it appears on an X-ray doesn't mean you'll have pain.
Mild cases of spondylolysis and spondylolisthesis usually cause minimal pain. In fact, the conditions are often found by accident when a person has a pre-employment exam or an X-ray of the back for an unrelated reason.
test uses X-rays to view the bony vertebrae in your spine and can tell your doctor if any of them are too close together or whether you have arthritic changes, bone spurs, fractures, or any slippage of the vertebrae (Fig. 4).
(MRI) scan is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of your spine. Unlike an X-ray, nerves and discs are clearly visible. It allows your doctor to view your spine 3-dimensionally in slices, as if it were sliced layer-by-layer like a loaf of bread with a picture taken of each slice. The pictures can be taken from the side or from the top as a cross-section. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. An MRI can tell your doctor where your spine is damaged and if there is any nerve compression. It can also detect bony overgrowth, spinal cord tumors, or abscesses.
is a safe, noninvasive test that uses an X-ray beam and a computer to make 2 dimensional images of your spine. Similar to an MRI, it allows your doctor to view your spine in slices, as if it were sliced layer-by-layer with a picture taken of each slice. It may or may not be performed with a dye (contrast agent) injected into your bloodstream.
Spondylolisthesis is the actual slipping forward of the vertebral body (the term "listhesis" means "to slip forward") (Fig. 3). It occurs when the pars interarticularis separates and allows the vertebral body to move forward out of position causing pinched nerves and pain. Spondylolisthesis usually occurs between the fourth and fifth lumber vertebra or at the last lumbar vertebra and the sacrum. This is where your spine curves into its most pronounced "S" shape and where the stress is heaviest.
As with spondylolysis, sporting activities that involve repetitive loading of the spine into flexion and/or extension, combined with rotation, places the lumbar spine at risk of developing a spondylolisthesis.