Spondylolytic Spondylolisthesis

Posted On: May 23, 2017

This is the ninth case review from my past practice. I am Dr. David Johnson a chiropractor and physical therapist in Highland Park and Lake Bluff. I am the director of North Shore Spinal and Sports Rehabilitation. I have practiced chiropractic and physical therapy on Chicago’s North Shore for almost 30 years. I started as a chiropractor in Lake Forest, Illinois in 1987. I integrated physical therapy into my practice in 1990.

This is case of a 14 year old, female basketball player who came to my Highland Park office with her mother complaining of lower back pain. She was suffering from lower back pain for 4 months and had already been to an orthopedic surgeon and another physical therapist in Highland Park.

She was an avid basketball player and was distraught because she couldn’t jump shoot and land without pain. She was a point guard for a local team and like many young athletes she played and trained all year.

Her pain was local to her back and she had no lower extremity pain. Neurologically she was intact. She had painful lumbar ranges of motion with extension being exquisitely painful. Palpation revealed that she had marked point tenderness over L5/S1 area on the left. I reviewed the x-rays from the previous providers and there were negative for fracture.

I sat down with the mother and daughter and I told them that I think she has an early stress fracture. The mother didn’t believe me. She protested that the x-rays were negative. I told her that x-rays don’t always show if there is an early fracture and that an MRI was a better choice. I also told her a high percent of young athletes with spine problems have these types of injuries. I pointed out that she had already been to physical therapy and it didn’t help.

I ordered the MRI of the lumbar spine. It came back and there was edema (excessive blood) in the left L5 pars interarticularis area. This is what one sees in early stress fracture. This can lead to a full facture. If the facture develops it is called a spondylolysis. If it happens on both sides it can allow for the vertebra to move forward and this is called a spondylolytic spondylolisthesis (Greek for spinal break and spinal slippage).

I had the patient not participate in basketball until the area was non-tender to palpation. We strengthened her with core exercises and stretched her hamstrings. She returned to training in 8 weeks and returned to play in 10 weeks. I saw her periodically over the years and she never developed a fracture.