Spondylolisthesis in Athletes - Causes, Symptoms, and Treatment

Introduction:

Kids and teens who play sports like football, weight-lifting, gymnastics, volleyball, ballet, wrestling, and golf can strain their lower back and have a high risk for spondylolisthesis. Young athletes are at more risk because of their growing bones, especially during the growth spurt. Most people recover soon by taking proper rest and doing exercises that help to stretch and strengthen their lower back.

What Is Meant by Spondylolisthesis?

Spondylolisthesis is a condition that occurs in the spine and causes lower back pain. In short terms, it is a spine instability that occurs when the vertebrae (spine bone) slip out onto the vertebrae below. This leads to pressure on the nerve and causes lower back pain. Spondylolisthesis is a Greek word, spondylos- spine or vertebrae, and listhesis- slipping, sliding, and movement.

Are Spondylosis and Spondylolisthesis the Same?

• Spondylosis: In this condition, the spine defect occurs due to stress fractures and cracks in spine bones, which are common in young athletes.

• Spondylolisthesis: In this condition, the vertebrae (spine bone) slip out of place and rests on the vertebrae below it. Spondylosis can cause spondylolisthesis when the fractured bone slips out due to stress fracture and degenerative conditions.

What Is the Pathophysiology of Spondylolisthesis?

The disks present between vertebrae and the facet joints (which link two vertebrae together through the back surface) wear down, which leads to overgrowth and backward growth of facet joints. This leads to an unstable and uneven surface area that makes the vertebrae have less ability to stay in place and puts pressure on the bone below it.

What Are the Types of Spondylolisthesis?

• Congenital: Occurs congenitally when the spine is not properly formed during birth. This causes slippage of vertebrae in later life.

• Isthmic: Spondylosis condition leads to spine fracture and causes slippage.

• Degenerative: This occurs due to aging. The disk loses its water which cushions the vertebrae and becomes thin and resulting in slippage.

Other types:

• Traumatic: Occurs due to injury to vertebrae which causes slippage.

• Pathological: Occurs due to osteoporosis and tumor.

• Post-surgical: Occurs due to spinal surgery, which leads to slippage.

What Are the Causes?

• Spine overextension in young athletes.

• Genetics.

• Thinner vertebral bone by birth.

• Wear and tear of the spinal disks (provides cushion to vertebrae) in older adults.

What Are the Symptoms?

• Lower back pain.

• The pain is referred to the thighs and buttocks region.

• Muscle spasm.

• Stiffness.

• Difficulty in walking and standing for a longer time.

• Pain on bending.

• Numbness, tingling, and weakness in the foot.

How to Diagnose?

A medical history will be collected by the physician. Next, the physician will do a physical exam for tenderness, numbness, and any tingling sensation. The physical tests include:

• Passive Lumbar Extension Test: During this test, the person should lie in a flat position with face downwards and then elevate both legs to a height of about thirty centimeters while the knees extend and pull the legs. The test is positive if the person experiences pain in the lower back during elevation.

• Prone Instability Test: The person should lie flat with face downwards. The trunk should be on the table, and the legs should be at the edge of the table with feet flat on the floor. The physician will then perform passive lumbar spine movements, and the test is positive if the person experiences pain.

• Active Straight Leg Raise Test: In this test, the person should lie flat with face upwards and then should raise the leg for about twenty centimeters off the table. The test is positive if the person feels any disability to raise their legs.

• Bridging Maneuvers: During this test, the person should lie flat with face downwards and propped on their elbows. The elbows are spaced apart, and the feet are placed with a narrow base and not touching. The person is asked to raise their pelvic region off the table while forearms and toes are in contact with the table. The test is positive if there is any pain.

• Other tests include a spinal X-ray to look for vertebrae out of place.

• Computed tomography and magnetic resonance imaging tests are used to see soft tissue such as disks and nerves.

What Is the Treatment Plan?

The treatment depends on the severity of slippage, age, symptoms, and overall health.

Non-Surgical Treatment:

• Rest: One should take a break from doing strenuous activities and playing sports.

• Medication: Nonsteroidal anti-inflammatory drugs like Ibuprofen can reduce pain.

• Injection: Corticosteroids injected directly into the affected area help to reduce symptoms.

• Physical Therapy: Should do exercises to strengthen the abdomen and back under the therapist's advice. Doing exercises on a regular basis helps to relieve pain.

• Bracing: The use of braces helps to stabilize the injured area and helps to heal faster. Bracing is not recommended in older adults.

Surgical Treatment:

• When the pain does not resolve under conservative management, then surgical treatment is the only option.

• Surgery relieves pain, stabilizes the spine, and restores function.

• Surgery involves spinal decompression with or without fusion.

• Decompression with fusion is done to treat isthmic spondylolisthesis and gives a better outcome than performing decompression alone.

• During decompression surgery, the bone and disk are removed and give space for nerves in the spinal canal, thereby reducing the pain.

• During fusion surgery, the two affected vertebrae are fused, and when they heal, they form into a single bone, thus eliminating the movement.

• The drawback of surgery is the person will have limited spinal flexibility.

What Are the Preventive Measures?

• Should do regular exercises to strengthen the abdominal and back muscles.

• Should maintain a healthy weight as increased weight puts stress on the lower back.

• Should follow a well-balanced diet to keep the bones strong and nourished.

Will Spondylolisthesis Recur After Treatment?

Minor slippage of the vertebrae usually resolves under conservative management and will not recur whereas in severe grades, the recurrence rate is high.

Conclusion:

Surgery has a high success rate, and the person can return to active life after surgery. Rehabilitation after surgery helps the person to get back to full function. Rehabilitation, including activity modification, education, and exercises, help the young athlete to be symptom-free and return to sports.