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Spondylolysis vs Spondylolisthesis

Both Spondylolysis and Spondylolisthesis are conditions that cause lower back pain in children and teenagers. They are different phases of what can happen with spinal fractures. 

What is Spondylolysis vs Spondylolisthesis?

Spondylolysis (also known as a pars stress fracture) is a non-displaced fracture of the spinal vertebra, in the area known as the pars interarticularis between the facets of the vertebra. This most commonly occurs in the L4 vertebra (although it can also occur in the L5 vertebra), and can happen on one side or both sides of the bone.

Spondylolisthesis (or anterolisthesis) occurs when Spondylolysis degenerates further. Spondylolisthesis is the forward displacement of a vertebra, when the pars interarticularis breaks and the injured vertebra slides forward onto the one below it. This can be classified into Low-grade vs High-grade Spondylolisthesis, dependent on whether surgery is needed or not.  

Other types of vertebral breaks are retrolisthesis (where the vertebra slips backwards), and laterolisthesis (where the vertebra slips sideways). If the Spondylolisthesis is extreme, it can become Spondyloptosis, where the vertebra is dislocated ie the upper vertebra translates entirely off the vertebra below. 

Spondylolysis vs Spondylolisthesis

Signs and Symptoms of Spondylosis vs Spondylolisthesis

Symptoms of Spondylosis include:

  • Spontaneous onset, unilateral back pain, which is sharp at first, and dull later
  • Pain may radiate to thigh or buttock
  • Pain aggravated by arching, standing or extension
  • Pain is eased by rest
  • Exaggerated back arch and tight hamstrings

Symptoms of Spondylolisthesis include:

  • Gradual onset low back pain, buttock or leg pain
  • Pain arching the back
  • Increased swayback
  • Tight hamstrings
  • A limp when walking
  • Neurological signs, such as sciatica, numbness, tingling, muscle tightness, muscle weakness, diminished reflexes

Causes of Spondylolysis vs Spondylolisthesis

Spondylolysis mainly occurs in early childhood or early adolescence. It is usually caused by overuse, where activities that overstress the pars inarticularis or hyperextend or over-rotate the lower spine result in stress fractures. These can be sports such as gymnastics, weightlifting, ice skating, bowling in cricket, dance and ballet, butterfly swimming and some track and field, such as javelin. It could also have a genetic cause, where some people are born with a thinner pars inarticularis, and thus more prone to stress fractures.

Spondylolisthesis can be divided into three categories - Isthmic, Degenerative and Congenital Spondylolisthesis. Isthmic Spondylolisthesis is the result of Spondylolysis, usually through trauma or overuse, and is usually seen in athletic pre-teens and adolescents. Degenerative Spondylolisthesis usually occurs in advancing years, and is the result of Spondylosis, Degenerative Disc Disease or Facet Joint Pain. Lastly, Congenital Spondylolisthesis occurs during early childhood, and is caused by poorly formed facet joint structure at birth leading to vertebral slippage.

Statistics and Epidemiology related to Spondylolysis vs Spondylolisthesis

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