- Main signs and symptoms
- Possible causes
- How the treatment is done
- When and how physical therapy is performed
Spondylolysis is a situation where there is a small fracture of a vertebra in the spine, which can be asymptomatic or give rise to a spondylolisthesis, which is when the vertebra 'slips' backwards, deforming the spine, which can press on a nerve and cause symptoms such as back pain and difficulty moving.
This situation is not exactly the same as a herniated disc, because in the hernia only the disc is affected, being compressed. In these cases, one (or more) spine vertebrae 'slide backwards', due to a fracture of the vertebral pedicle and shortly afterwards the intervertebral disc also accompanies this movement, reaching backwards, causing back pain and tingling sensation. However, in some cases it is possible to have a spondylolisthesis with a herniated disc at the same time.
Spondylolysis and spondylolisthesis are more common in the cervical and lumbar regions, but they can also affect the thoracic spine. Definitive healing can be achieved with surgery that reposition the spine in its original location, but treatments with drugs and physical therapy may be sufficient to relieve pain.
Main signs and symptoms
Spondylolysis is the initial stage of spinal injury and, therefore, may not generate symptoms, being discovered accidentally when performing an X-ray examination or tomography of the back, for example.
When spondylolisthesis is formed, the situation becomes more serious and symptoms such as:
- Intense back pain, in the affected area: bottom of the back or neck region; Difficulty performing movements, including walking and practicing physical activity; Low back pain can radiate to the butt or legs, being characterized as sciatica; Tingling sensation in the arms, in case of cervical spondylolisthesis and in the legs, in case of lumbar spondylolisthesis.
The diagnosis of spondylolisthesis is made through an MRI that shows the exact position of the intervertebral disc. Usually the diagnosis is made after the age of 48, with women being the most affected.
Possible causes
The most common causes of spondylolysis and spondylolisthesis are:
- Spinal malformation: these are usually changes in spine positioning that arise from birth and that facilitate the displacement of a vertebra during adolescence when practicing artistic or rhythmic gymnastics, for example. Blows and trauma to the spine: can cause deviation of a vertebra of the spine, especially in traffic accidents; Diseases of the spine or bones: diseases such as osteoporosis can increase the risk of displacement of a vertebra, being a common condition of aging.
Both spondylolysis and spondylolisthesis are more common in the lumbar and cervical regions, causing pain in the back or neck, respectively. Spondylolisthesis can be disabling when it is severe and the treatments do not bring the expected pain relief, in which case the person may have to retire.
How the treatment is done
The treatment for spondylolysis or spondylolisthesis varies according to the intensity of the symptoms and the degree of displacement of the vertebra, which can vary from 1 to 4, and can be done with anti-inflammatory drugs, muscle relaxants or analgesics, but it is also necessary to do acupuncture and physiotherapy, and when none of these options is sufficient for pain control, surgery is indicated. The use of a vest was used in the past, but it is no longer recommended by doctors.
In case of spondylolysis it may be recommended to take Paracetamol, which is effective in controlling pain. In the case of spondylolisthesis, when the deviation is only grade 1 or 2, and, therefore, treatment is done only with:
- Use of anti-inflammatory drugs, such as Ibuprofen or Naproxen: decrease the inflammation of the discs of the vertebrae, relieving pain and discomfort. Corticosteroid injections, such as Dexa-citoneurin or Hydrocortisone: are applied directly to the displaced vertebrae to quickly relieve inflammation. They need to be made between 3 to 5 doses, repeated every 5 days.
As for surgery, to strengthen the vertebra or to decompress the nerve, it is only done in cases of grade 3 or 4, in which it is not possible to control the symptoms with medication and physiotherapy, for example.
When and how physical therapy is performed
Physiotherapy sessions for spondylolysis and spondylolisthesis help to complete treatment with medications, allowing you to relieve pain faster and reducing the need for higher doses.
In physiotherapy sessions exercises are performed that increase the stability of the spine and increase the strength of the abdominal muscles, decreasing the movement of the vertebrae, facilitating the reduction of inflammation and, consequently, relieving pain.
Electronic equipment for pain relief, manual therapy techniques, lumbar stabilization exercises, abdominal strengthening, stretching of the tibial hamstrings located on the back of the legs can be used. And RPG exercises, Clinical Pilates and Hydrotherapy can be recommended, for example.
