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Lower Back Pain: Could My Active Child Have Spondylolysis?

Lower back pain is the most common health problem among older adults. While this is a sad but true state of affairs for us adults, what about lower back pain in children?

If your child or teen is experiencing low back pain that worsens with physical activity, they may be suffering from more than a muscle strain. There’s a chance they could be dealing with a condition known as spondylolysis.

Spondylolysis is one of the most common causes of low back (lumbar) pain in young adults. Read on to learn more about this potentially painful condition. 

What is spondylolysis?

Spondylolysis refers to the separation of bone or a crack (fracture) in the vertebrae, the small bones that stack together to make up the spine. It’s a big word for a little fracture but is very common in children, especially those of high school age. 

“The defect is located in the area of the vertebra called the pars interarticularis that connects the facet joints at the back of the spine,” said Justin Esterberg, MD, an orthopedic spine surgeon at Banner Health Clinic in Gilbert, AZ. “The facet joints help the spine bend, twist and extend in different directions and protects the spinal cord. Repetitive use and stress on these joints, however, can cause stress fracture and spondylolysis.”

In some cases, if a fractured vertebra weakens so much that it slips out of place and onto the vertebra below, this is called spondylolisthesis. “However, a child can have one without the other,” Dr. Esterberg noted. “Spondylolisthesis may have other causes as the vertebra can be weak and defective since birth or it could be broken due to an injury or stress.”

How does spondylolisthesis, or a slipped vertebra, differ from a slipped disc?

A slipped disc, also called a herniated disc or ruptured disc, has one distinct difference from a slipped vertebra – soft tissue versus a bony vertebra.

“A slipped disc occurs in the soft interior of the spinal disc that misaligns, bulges or tears, whereas with spondylolisthesis, bony vertebra slips,” Dr. Esterberg said. “Both can be painful and result in similar symptoms including low back pain and/or radiating pain into the leg or legs.”

How does spondylolysis differ from spondylosis?

With all this spondy talk, it’s easy to quickly gloss over and confuse spondylolysis and spondylosis. But before we move on, it’s important to understand the difference between these two conditions as well. 

“Unlike spondylolysis, spondylosis is not a fracture but is an age-related degenerative condition more common in older adults,” Dr. Esterberg said. “The majority of patients older than 70 have spondylosis in their spine which may or may not cause pain.”

What causes spondylolysis?

One common cause is repetitive movements like hyperextension or repeatedly bending the spine backward while twisting or turning. “We see this often in children who participate in certain sports like gymnastics, dance, weightlifting, football, volleyball, soccer and diving,” Dr. Esterberg said. 

These movements along with rapid growth, such as growth spurts, as your child develops can put them at greater risk for pain and spinal instability.

What are the symptoms of spondylolysis?

Most acute low back pain, meaning pain that comes on suddenly, is related to muscle strain. However, spondylolysis-related pain will likely go on much longer. It may even worsen with activity or spine extension. Pain may travel down to the buttocks, thighs and leg region. 

In addition to pain, if your child is experiencing numbness or tingling in their feet, this could be another possible symptom of spondylolysis.

How is spondylolysis diagnosed and treated?

If your child has low back pain, they should be seen by their health care provider or a spine or sports medicine specialist, especially if your child’s sport or activity involves hyperextension.

Typically, an x-ray is the only test needed, however other imaging tests, such as an MRI or CT scan, may be done to get more details about your child’s spine.If your child is diagnosed with spondylolysis, it is most often treated first with rest and time off from their sport and other contact sports to give your child’s spine time to heal and feel better.

“In addition, your provider may recommend physical therapy to strengthen thigh muscles and back muscles and bracing to hold the spine in an upright position,” Dr. Esterberg said. “Bracing may be used for a period of six weeks or so to allow the pain to calm down.”

In rare cases where these measures are unsuccessful, minimally invasive surgery may be necessary.

Can spondylolysis be prevented?

There are no perfect prevention strategies for spondylolysis, however it’s important that your child stays in good shape and maintains a healthy weight. “In particular, learning how to properly warm up and stretch, use good lifting techniques and incorporate core muscle exercises may also reduce the risk of developing spondylolysis,” Dr. Esterberg said.

What is the long-term outlook for kids with spondylolysis?

The long-term outlook for children with spondylolysis is good. 

“Most patients improve and get back to their sport within six to 12 weeks,” Dr. Esterberg said. “However, some children may develop issues down the road, so it’s important to follow these issues closely with their provider or spinal specialist so problems don’t develop.”

If your child or young adult athlete is experiencing low back pain, contact their provider or an orthopedic or spine specialist. To find a Banner Health expert near you, visit bannerhealth.com.

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