Author: John Cunningham

Isthmic Spondylolisthesis

Hello.

Many young people suffer from back pain but it is usually the kind of pain that gets better by itself over a few days to weeks. Occasionally, though, back pain can persist and it may become worth investigating, especially if it is associated with leg pain, or “sciatica”. A particular condition that can cause lower back pain and sciatica in younger people is isthmic spondylolisthesis. Well what on earth is that, you ask.

Isthmic spondylolisthesis, or IS, for short, is a condition that you might think of as a stress fracture in your lower back. It usually develops when you’re a teenager, and it occurs more frequently in sportspeople that perform a lot of extension activities like gymnasts, fast bowlers and baseball pitchers, but it can occur in people who don’t play any sport either. If it is picked up when you’re really young sometimes the problem, or “defect”, can be repaired. Unfortunately, it often goes unrecognised and only later in life becomes symptomatic.

The defect is in a part of the spine called the “isthmus”, or “pars interarticularis” (pars for short). It is most common at L5, and most commonly leads to a spondylolisthesis, or “slip”, or L5 on the sacrum.

The progress of isthmic spondylolisthesis

isthmic spondylolisthesis

As you can see in the diagram to the right, the pars links the L5 vertebra to the sacrum. If this is broken, the L5 vertebra is only held onto the sacrum by ligaments, and these over time stretch and may fail. This includes the disc between L5 and the sacrum. If you think about it, the whole weight of your upper body – your head, arm, thorax and abdomen – is all bearing down on this segment of your spine, so it’s no surprise that over time, if there’s no bone holding them together, that the ligaments will fail.

So that’s what it is. What can be done about it? You’ll have to wait for my next post…

John

How to look after your spine

In many ways, this post may be the one to put me out of business, but it’s also the post which I’m sure should be my first – how to protect and look after your back.  In medicine the preference is always prevention over cure, yet many of us forget to emphasise the benefits of spine health.  In other words, how can we all look after the health of our spine in order to prevent injury, reduce the symptoms of spinal degeneration, and lastly to speed recovery following injury or surgery.  Let’s get to the point, and keep it simple.

1. Don’t smoke.  There is nothing healthy about smoking, and it is known that smoking leads to accelerated disc degeneration.  It also increases your chances of an adverse event during and after surgery, and may contribute to failure of spinal fusion surgery in the neck and lower back.  http://www.ncbi.nlm.nih.gov/pubmed/11339862

2. Lose weight.  Every kilo your carry leads to an extra 8 kilo’s of force going through your spine.  Thin people are putting less stress through their spine, and losing weight is often a very effective strategy to lessen the symptoms of a degenerating spine.

3. Exercise. Exercise will obviously help you control your weight, but strength training, particularly of the “core” muscle groups, will also help stabilise the spine and reduce some of the impacts that it sustains.  Some people wear a corset device to help them with their backs.  Improving your core strength works in a similar manner.

4. Maintain good posture.  Maintaining a good posture will allow the spine to take loads in the way that it was designed to.  Good posture also refers to good lifting techniques such as bending your knees, and holding heavy loads close to your body.  Core strength will help you to also maintain a good posture.

Is that all?  No.  Now that you’ve read this, it’s up to you to make a start.  Your GP can help you with quitting smoking, and there’s lots of resources available to you on the internet such as QUIT.  Your GP and physiotherapist can also help you to lose weight in a healthy and appropriate manner – some people are even electing to have “gastric banding”, but that is something you really need to see a specialist about.  Your local physiotherapist will be able to show you good core strengthening exercises, and there’s some available from the Mayo Clinic and the AAOS on the internet.

Some other great resources for learning about your spine are available via the links below:

All the best,

John