The lumbar spine is made of five vertebrae. Its two primary purposes are to allow us to move the lower back, and to protect the nerves that travel through it. A fracture or defect through a portion of the vertebrae (pars articularis) can result in a condition referred to as spondylolysis. This defect can be seen on an X-ray, CT scan or MRI of the lumbar spine.
If this defect becomes unstable, the vertebrae may slip out of normal alignment. This condition is called spondylolisthesis. Most patients may not have any pain with a spondylolysis or spondylolisthesis. However, some will describe low back pain, tightness and spasming. Others can develop leg pain, numbness, tingling and weakness if the vertebra slips enough to cause pressure on the nerves. If the vertebrae are pressing on the nerves, a MRI or CT scan can be ordered for additional information before treatment is recommended.
Initial treatment for spondylolysis and spondylolisthesis is always non-surgical. Physical therapy is the best treatment. Activity modification, anti-inflammatories and muscle relaxers may help with low back pain. Sometimes, a back brace may be recommended. Most patients can resume activities gradually. Some patients may have intermittent flares of low back pain with strenuous activities and heavy lifting. A home core stretching and strengthening program to focus on back and abdominal muscles will help prevent future exacerbations of low back pain.
A lumbar spine fusion may be required if the spine becomes unstable and the vertebrae continues to slip out of place, and/or back pain does not respond to conservative treatment.
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