​​Spondylolisthesis in Children and Adolescents

Spondylolisthesis is a condition involving spinal instability. It develops when a vertebra slips out of its normal position and rests on the vertebra below. This can trigger back pain and nerve compression. 

Though common in older adults, spondylolisthesis is a prevalent cause of lower back pain in children and adolescents. In this article, we’ll discuss how spondylolisthesis affects younger patients and what can be done to treat it.  

How Does Spondylolisthesis Occur in Adolescents?

Spondylolisthesis most often occurs in adolescents as a result of spondylolysis, which is a stress fracture in the pars interarticularis. This is known as isthmic spondylolisthesis. 

The pars interarticularis is a piece of bone that links the spine’s upper and lower facet joints. When it fractures, it destabilizes the affected vertebrae, potentially causing spondylolisthesis. 

Symptoms of Spondylolisthesis in Children and Adolescents

The most common symptoms of spondylolisthesis in children and adolescents include:

  • Lower back pain
  • Thigh and buttock pain
  • Muscle stiffness in the lower back
  • Tenderness in the lower back
  • Tight muscles (particularly the hamstrings)

Lower back pain from spondylolisthesis may feel like a back muscle strain. However, it persists longer than a muscle strain and will likely worsen without proper care. 

In some cases, the vertebra moves far enough out of its proper position to impinge on the spinal nerves. This can trigger worsened pain and neurological symptoms, such as:

  • Pain that radiates from the lower back down the legs
  • Weakness in the legs or difficulty walking
  • Numbness and tingling in the lower extremities

Rarely, spondylolisthesis can cause urinary incontinence and permanent nerve damage if it’s left untreated. 

What Is the Most Common Type of Spondylolisthesis in Children?

The most common types of spondylolisthesis in children are isthmic and congenital.

Congenital spondylolisthesis may also be called dysplastic spondylolisthesis. It results from a genetic spinal defect that’s present at birth. The defect affects the facet joint(s) of the spine, which compromises the stability of the entire vertebral column. 

What Is the Most Common Age for Spondylolisthesis?

The most common age for isthmic spondylolisthesis is around age 6, or in adolescents. 

The most common age for degenerative spondylolisthesis is over 50. Degenerative spondylolisthesis develops from age-related wear and tear on the spine. Age causes the intervertebral discs and other vertebral structures to thin and weaken. This increases the likelihood that a vertebra will slip out of place.  

What Are the Risk Factors for Spondylolisthesis in Children?

Risk factors for spondylolisthesis in children include:

  • Repeatedly overextending the spine, typically in sports 

Young athletes are more likely to experience spondylolisthesis than those who don’t partake in sports. Many sports place significant impact on the spine, including the pars interarticularis, and may lead to spinal stress fractures. 

  • Genetic spinal defects

Some individuals are born with a defect in the pars interarticularis that can cause spondylolisthesis. Not all genetic spinal defects of the pars interarticularis trigger spondylolisthesis symptoms. 

  • Obesity

Children and adults who are overweight or obese have a higher risk of developing spondylolisthesis. Excess weight increases the impact on the spine with daily movements, which may heighten the risk of a stress fracture in the pars interarticularis. 

Which Sports Cause Spondylolisthesis?

The following sports are the most likely to cause spondylolisthesis in children and teens:

  • Soccer
  • Football
  • Diving
  • Gymnastics
  • Weightlifting
  • Tennis
  • Baseball 

These sports are thought to increase the risk of spondylolisthesis because they involve repeatedly twisting and extending the spine. These movements impart a significant impact on the spinal tissues, including the pars interarticularis. 

Is Spondylolisthesis Common in Children?

Spondylolisthesis is a common cause of lower back pain in children. 

In one study, the incidence of spondylolysis (a pars interarticularis stress fracture) in children under age 11 was 2.5%. The incidence of spondylolysis by age 6 had been reported at 4.4%

How Is Spondylolisthesis Diagnosed in Children and Adolescents?

Spondylolisthesis is diagnosed in children and adolescents with imaging tests, such as X-rays, CT scans, and lumbar MRI scans. 

  • X-rays use electromagnetic waves to create images of the body, which may show that a vertebra has slipped out of position. 
  • CT scans (computed tomography scans) use both X-rays and computer technology to create images of the inside of the body. CT images display details of bone, muscle, organ, fat, and blood vessel tissue. 
  • MRI scans (magnetic resonance imaging) use radio waves and a magnetic field to show the inside of the body in detail, like CT scans. However, MRIs provide a more detailed image of soft tissue than CT scans. 

How Is Spondylolisthesis Treated in Children and Teens?

Spondylolisthesis is typically treated in children and teens with conservative therapies. Surgery is rarely required to resolve symptoms of this spinal condition, especially in young patients. 

Most young athletes who develop spondylolisthesis from a pars interarticularis fracture make a complete recovery with a prompt diagnosis and conservative treatment. They can usually make a full return to sports participation. 

The most common treatments for spondylolisthesis in children and adolescents include:

Activity Modifications

The first step in treating spondylolisthesis in kids and teens is to limit activities that worsen symptoms. Young athletes with spondylolisthesis will likely need to take a break from sports until their pain improves. However, to retain strength and stamina, patients may be able to safely engage in low-impact exercise, like swimming. 

Make sure to follow all of your physician’s recommendations for exercising with spondylolisthesis. 

Bracing

Bracing the back can provide spinal stability during your spondylolisthesis recovery. A brace can help the pars interarticularis heal properly by supporting the spine. 

A brace for spondylolisthesis, sometimes referred to as a lumbar brace or corset, compresses the abdomen to reduce impact on the spinal column. This temporarily limits your range of motion, which prevents strain on the spine. The brace may also provide pain relief.  

As a drug-free, non-surgical treatment, bracing is one of the most widely recommended therapies for spondylolisthesis in children and adolescents. 

Physical Therapy

Physical therapy is an important stage of treatment for kids and teens with spondylolisthesis. It involves stretches and strengthening exercises to alleviate impact on the spine. For spondylolisthesis, the physical therapist will likely focus on strengthening the back and abdominal muscles, which provide support for the spinal column. 

Additionally, many patients with spondylolisthesis have tight hamstrings, which can cause worsened pain and diminished function. Physical therapists can provide stretches and other methods to loosen the hamstring muscles safely. 

Pain Medications

Especially in the early stages of recovery, your physician may recommend pain medications, like NSAIDs, to manage spondylolisthesis symptoms. NSAIDs (nonsteroidal anti-inflammatory drugs) can lessen pain and swelling in the spine. 

When is Surgery Required for Spondylolisthesis in Kids and Teens?

Surgery may be required for spondylolisthesis in kids and teens in severe cases that pose a risk of permanent nerve damage or disability. 

In these cases, the vertebra has usually slipped far out of its normal alignment and continues to worsen despite conservative therapies. Spondylolisthesis surgery involves alleviating pressure on the spinal nerves (known as decompression) and stabilizing the spine, either with spinal fusion or a non-fusion implant

If your child is exhibiting symptoms of spondylolisthesis, schedule an appointment with a physician near you for an evaluation.