Effective Treatment for Lumbar Spondylosis: A Comprehensive Guide

What is Lumbar Spondylolisthesis?

“Lumbar spondylolysis” describes either a one-sided or double-sided bony defect (fracture) affecting a part of the lumbar vertebrae called the Pars Interarticularis. 90% of these defects occur at the L5 level. When this defect occurs on both sides of the spine, it can cause a “slippage” of that segment forward relative to the segment below it.

Overall, treatment for lumbar spondylosis is extremely important since spondylolysis affects approximately 6% of the general population, and up to 8-14% of elite adolescent athletes. The condition affects males almost twice as often as females.

The cause of spondylolysis is attributed to repetitive loading, especially in lumbar extension (back bending) - from bony impingement of an upper vertebrae’s joints onto the lower. Repetitive stress leads to bony fatigue with an ensuing stress reaction and eventual stress fracture. The condition may occur more commonly in the presence of congenital abnormalities. Two-thirds of cases occur prior to first grade, with the remainder occurring during later childhood or adolescence, it is important to consider all available options when seeking treatment for lumbar spondylosis. The condition is the most common cause of chronic low back pain in adolescent athletes; The highest likelihood of lumbar spondylolisthesis occurs in track & field throwing sports, gymnastics, and rowing. Other at risk athletic populations include those who participate in: diving, cheerleading, football, wrestling, weight lifting, rowing, track and field, swimming, tennis, and volleyball. Cases developing before adolescence seem to be less symptomatic, or possibly less recognized. The presence of spondylolysis in an adult is likely an incidental finding.

What Will Lumbar Spondylolisthesis Look and Feel Like?

The typical presentation includes chronic low back pain that is provoked by activity and relieved by rest. Symptoms may develop acutely but more commonly are present in a slowly progressive fashion. Treatment for lumbar spondylosis should be considered in every adolescent athlete who presents with low back pain.

Typically, one may have tenderness to palpation over the bony areas of the spine (spinous process)and/or demonstrate decreased range of motion due to pain in the back bending position (extension). There are not typically neurologic findings associated with lumbar spondylolisthesis. Chronic soft tissue irritation around these areas of the spine often accompany this condition and may require stretching or massage to muscle groups like the lumbar erector muscles, glutes and hamstrings. Postural deficits can also be contributing to the problem and are important to address.

How Do We Treat Lumbar Spondylolisthesis?

Since the etiology of spondylolysis is excessive stress, the primary treatment modality is relative rest. Conservative treatment for lumbar spondylolisthesis is the standard of care and generally consists of activity restriction/modification, therapeutic exercise, core stabilization, aerobic conditioning, and certain modalities.

The duration of activity restriction/modification is related to the severity of the injury, as identified by advanced imaging. Acute and active stress fractures have a high potential for healing (especially when only on one side) and may require up to three months of rest – as this is the shortest amount of time required for complete healing as identified by advanced imaging techniques. If one has a more chronic lesion, bony reunion is unlikely, and therefore relative rest is less important. Pain relief and restoration of function can generally be achieved by the treatment for lumbar spondylolisthesis without the use of a supportive brace.

After adequate rest, the patient may begin low-impact aerobics and core stability training. Rehab would be directed at strengthening muscles of the abdomen, hips and legs to promote improved body mechanics and core stability around the injury. Patients completing a 10-week rehab program, including abdominal and core stability demonstrate significantly decreased pain intensity with sustained improvement. Proper breathing mechanics also can have a dramatic effect on lumbar stability and may be a part of a well-rounded rehabilitation process for each athlete but with the proper treatment for lumbar spondylosis, the focus can be on a successful return to sport. Later rehab focuses on sports specific training, emphasizing proper biomechanics and function.

Return to sport may be achieved when the athlete has reestablished a full pain-free range of motion in a sports-specific controlled environment. Rehab of an early active fracture may require two to four months, meaning that the athlete may be out of their sport for a total of five to seven months.

If you are suffering from low back pain or low back related to lumbar spondylolisthesis, click below to make an appointment to see how our doctors can help!