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Spondylolysis & Listhesis

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.

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