 |
||
|
The spine is made up of a series of connected bones called vertebrae. In about 5% of the adult population, there is a developmental crack in one of the vertebrae, usually at the point where the lower (lumbar) part of the spine joins the tailbone (sacrum). It may develop as a stress fracture. Due to the constant forces the low back experiences, this fracture does not usually heal as normal bone. This type of fracture (called a spondylolysis) is simply a crack in part of the vertebra (Figure 1) and may cause no problem at all. However, sometimes the cracked vertebra does slip forward over the vertebra below it. This is known as adult isthmic spondylolisthesis. Spondylolisthesis may not cause any symptoms for years (if ever) after the slippage has occurred. If you do have symptoms, they may include low back and buttock pain; numbness, tingling, pain, muscle tightness or weakness in the leg (sciatica); increased sway back; or a limp. These symptoms are usually aggravated by standing, walking and other activities, while rest will provide temporary relief. Studies have shown that 5-10% of patients seeing a spine specialist for low back pain will have either a spondylolysis or spondylolisthesis. However, since spondylolisthesis is not always painful, the presence of a crack (spondylolysis) and slip (spondylolisthesis) on the x-ray does not mean this is the source of your symptoms. Your doctor will begin by taking a history and performing a physical examination and may order x-rays of your back. However, sometimes it is difficult to see a crack and/or slippage on an x-ray, so additional tests may be needed. A computed axial tomography (CT) scan can show a crack or defect in the bone more clearly. A magnetic resonance imaging (MRI) study may be ordered to clearly show the soft tissue structures of the spine (including the nerves and discs between the vertebrae) and their relationship to the cracked vertebra and any slippage. It also will show whether any of the nearby discs have suffered any wear and tear because of the spondylolisthesis (slippage). If your doctor determines that a spondylolisthesis is causing your pain, he or she will usually try non-surgical treatments at first. These treatments may include a short period of rest, anti-inflammatory medications (orally or by injection) to reduce the swelling, analgesic drugs to control pain, bracing for stabilization, and physical therapy/exercise to improve your strength and flexibility so you can return to a normal lifestyle. If you are told to rest, follow your doctor's directions on how long to stay in bed. Generally, if recommended at all, this would be limited to a few days. (Strict bed rest is usually not necessary.) Ask your doctor whether you should continue to work while you are being treated. Your doctor may also, with the help of a nurse or physical therapist, begin education and training in performing activities of daily living without placing added stress on your lower back. If a combination of medication and therapy fails to provide relief, your doctor may order additional tests which will provide greater detail so he/she can plan further treatment. Medications and Pain Management Your doctor may use one medication or a combination of medications as part of your treatment plan. Medications used to control pain are called analgesics. Most pain can be treated with non-prescription medications like aspirin, ibuprofen, naproxen or acetaminophen. Some analgesics, referred to as nonsteroidal anti-inflammatory drugs, or NSAIDs, are also used to reduce swelling and inflammation that may occur. These include aspirin, ibuprofen, naproxen and a variety of prescription drugs. If your doctor gives you analgesics or anti-inflammatory medications, you should watch for side effects such as stomach upset or bleeding. Chronic use of prescription or over-the-counter analgesics or NSAIDs should be monitored by your physician for the development of any potential problems. If you have severe persistent pain that is not relieved by analgesics or NSAIDs, your doctor might prescribe narcotic analgesics (such as codeine) for a short time. Take only the medication amount that is prescribed. Taking a larger dosage does not help you recover faster. Side effects include nausea, constipation, dizziness and drowsiness and can result in dependency. All medication should be taken only as directed. Make sure you tell your doctor about any kind of medication you are taking, even over-the-counter drugs, and inform your doctor whether or not your medication is working for you. There are other medications that also have an anti-inflammatory effect. Corticosteroid medications, either orally or by injection, are sometimes prescribed for more severe back and leg pain because of their very powerful anti-inflammatory effects. Corticosteroids, like NSAIDs, can have side effects. Risks and benefits of this medication should be discussed with your doctor. Selected spinal injections, or blocks, may be used to relieve symptoms of pain. These are injections of corticosteroid into the epidural space (the area around the spinal nerves) or facet joint (between vertebrae) performed by a doctor with special training in this technique. The initial injection may be followed by one or two more injections at a later date. These are most often done as part of a comprehensive rehabilitation and treatment program. As you begin a physical therapy regimen and/or exercise program, your doctor may prescribe therapies like ultrasound, electric stimulation, hot packs, cold packs, and manual (hands on) therapy to reduce your pain and muscle spasms. At first, the exercises you learn may be gentle stretches or posture changes to reduce the back or leg symptoms. When you have less pain, more vigorous aerobic exercises (such as stationary bicycling or swimming) combined with strengthening/stretching exercises will likely to be used to improve flexibility, strength, endurance and the ability to return to a more normal lifestyle. Developing your back and stomach muscles will help stabilize your spine and support your lower body. Exercise instruction should start right away and be modified as recovery progresses. Learning and continuing an exercise and stretching program are also important parts of treatment, as is maintaining a reasonable body weight. The presence of this cracked vertebra (spondylolysis) or slippage (spondylolisthesis) by itself usually does not represent a dangerous condition in an adult. Therefore, treatment is aimed at pain relief and increasing the patient's ability to function. Although none of the non-surgical treatments will correct the crack or slippage, they can provide long lasting pain control without requiring more invasive treatment. Surgery
is reserved for that small percentage of patients whose pain cannot
be relieved by non-surgical treatment methods. The pain may be caused
by a pinched nerve, movement of the unstable cracked vertebra, or
from nearby discs which are being affected. If a spinal nerve is
being compressed by the forward slip, surgery may be needed to reopen
a tunnel, or space, for the nerve. |
Where Does it Hurt? | Education | FAQ | Testimonials
Our Office is Located Just South of Holy Cross Hospital
1930 NE 47th Street, Suite 300 Fort Lauderdale, FL, 33308
