Spondylolysis refers to a defect in the morphology of the lumbar rachis. This occurs when the vertebral isthmus (a thin strip of bone connecting the superior and inferior facets of the spine) becomes deformed somehow. If the problem is bilateral, posterior stability is lost and anterior slipping of the L5 vertebra (in most cases) over the sacrum can follow.
The cause of this is not fully known, but some researchers believe some individuals may simply have a congenital weakness of the isthmus. Repetitive microtraumas or a single severe trauma can cause the onset of this condition.
This disease is the main cause of lower back pain in adolescents and young athletes. This disease is essentially benign, but it tends to advance over the years and be a cause of instability to the lumbar spine. For this reason it is better to control it with clinical and instrumental exams.
The first step is clinical diagnosis, although several tests may need to be carried out in order to confirm this diagnosis, an X-ray of the lumbosacral region is typically the most supportive of these tests.
In the most advanced cases, listhesis can cause stenosis, resulting in nerve compression and symptoms radiating from this area. Conservative therapy is preferred and consists of strengthening exercises that reduce the sliding movements of the vertebral body, increasing the retroversion of the pelvis and decreasing the lumbar lordosis. Further to this, physical therapy and manual therapies are used, depending on the clinical manifestation of the disease.
Dorsal laminectomy – Surgical Interventions
A dorsal laminectomy is a surgical procedure designed to reduce the cord compression of the lumbar spine (lumbar spinal stenosis). It is performed under general anesthesia and involves the removal of a portion of the vertebral bone called the lamina. The lamina helps to form the posterior vertebral arch of the spine.
The most frequent cause of spinal cord compression is a lumbar disc herniation (also known as a slipped disc). Other possible causes may include osteoarthritis, spondylosis and spondylolisthesis.
The typical symptoms described in lumbar disc herniation include pain that may move down the leg, tingling and sensory disturbance of the skin over the leg (paraesthesia) and possible leg or foot weakness.
Depending on the severity, the initial therapy of choice may be conservative which involves an individually prescribed programme of rehabilitation and physiotherapy sessions. Once our Isokinetic doctor has made the diagnosis and if indicatedthese individually tailored sessions may be prescribed. Our well-trained physiotherapy and rehabilitation specialists will support you throughout your sessions in order for you to reach your maximum functional recovery possible.
In cases where physiotherapy and rehabilitative treatment alone cannot guarantee a good recovery, a surgical procedure, for instance a laminectomy may be indicated. We have a very good working relationship with spinal surgical teams and can request a surgical opinion if the doctor feels this is the best treatment option. Our team at Isokinetic will ensure you are fully informed or your progress.
Spondylolysis & Listhesis – Rehabilitation
Clinically the spondylolysis is mostly asymptomatic and can reveal after prolonged standing and with poor translation (walking to the shops) or after an occasional physical performance; in cases of spondylolisthesis (vertebral isthmus rupture) the clinical picture varies greatly depending from the front of the vertebra slipping and needs rehabilitation treatment.
The first objective is the reduction of pain through relaxing manual therapy of shortened low back paravertebral for the frequent association with high lumbar lordosis; you need to reach a good flexibility of the posterior chain through stretching exercises for lumbar paravertebral, the buttocks, the hamstrings, the iliopsoas, avoiding postures extension (Mc Kenzie) that can accentuate the front sliding of the vertebra.
If the listhesis is stable you can set a rehabilitation protocol by enhancing selective abs, core muscles of the buttocks with the aim of creating a natural corset that stabilizes the lumbar spine in static and dynamic with isometric contractions combined with breathing exercises till reaching to perform exercises with Bobath balls for advanced control of the pelvis and gluteal muscles.
The rehabilitation program ends with a gradual recovery of the sport specific gesture with field exercises for the recovery of specific athletic movement, proprioception, and vestibular function. In this last phase it is advisable to use a lumbotrain (protective brace for your lower back) both during the activity as well as whenever you have to lift weights.