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Chronic Back Pain: Overview and Management
July 22, 2017

An Overview of Isthmic Spondylolisthesis and Treat

The lumbar spine

Isthmic Spondylolisthesis is a disorder triggered by one vertebra sliding forward on the one underneath it. This situation happens as a result of a minor fracture in the bony area uniting the two joints in the rear portion of the spine. Isthmic Spondylolisthesis usually occurs during childhood, but symptoms do not appear until maturity. The condition is rare, affecting only 5 to 7% of the population, with 80% of people never experiencing any symptoms.

The fracture is most often seen in the lumbar spine at the L5 – S1 level but can happen as high as L3.
Isthmic Spondylolisthesis is caused by a break in the isthmus, known as the pars interarticularis. The pars interarticularis connects the facet joints of the two vertebrae. The area is thin and receives minimal blood supply, thus making it prone to stress fractures. The fracture is due to repeated stress and rarely produces pain.

For individuals experiencing symptoms with Isthmic Spondylolisthesis, the most frequent are:

  • A deep ache in the lower back
  • Pain extending to the buttocks, thighs, below the knee, and down to the foot
  • Leg fatigue and numbness or tingling
  • Pain exacerbated with standing, walking, or backward bending that is relieved with reclined sitting
  • Tight hamstrings

A physician will perform a comprehensive review of medical history and conduct a thorough physical examination to diagnose Isthmic Spondylolisthesis. X-rays, a CT scan, and an MRI can help confirm the presence of the condition.

Treatment for Isthmic Spondylolisthesis begins with conservative measures such as pain medication, and hot and cold therapy. Epidural steroid injections can provide relief in situations when pain is severe. Physical therapy, when appropriate, starts with stretching the hamstrings and gradually adding in other exercises. Chiropractic manipulation can also help relieve pain by mobilizing the affected joint. If surgery is needed, the options are a posterior lumbar fusion, which is the procedure of choice or an anterior lumbar fusion.

If you are experiencing deep lower back pain and leg fatigue and would like to schedule a consultation, please call our offices in New Braunfels or Seguin.

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