When it comes to child and adolescent back pain, Spondylolysis and Spondylolisthesis are the most common culprits

By: Howard A. McMahan, M.D., Resurgens Orthopaedics

Most people associate back pain with old age, but parents with young children and adolescences should be aware that this type of injury is certainly possible in the early stages of life as well. The most common causes of child and adolescent back pain are spondylolysis and spondylolisthesis.

Spondylolysis is essentially a stress fracture in one of the spinal vertebrae; these kinds of fractures typically occur in the lower back. At a more advanced stage the stress fracture can cause the vertebrae to weaken and shift out of place, this condition is called spondylolisthesis.

It is estimated that nearly 6% of all children have spondylolysis by age 6.

Cause – Although underlying causes of spondylolysis and spondylolisthesis have not been firmly proven, physicians speculate that they could be traced back to both genetic and environmental causes. Individuals can be born with thin vertebral bones and therefore genetically more susceptible to developing these conditions.

On the other hand, children who take part in sports that require them to frequently arch their backs experience fractures in the backbone more often than other children. Some of the most common sports that cause these injuries are gymnastics, football, volleyball and competitive swimming. 

Diagnosis – If a physician suspects a child or adolescent is suffering from spondylolysis or spondylolisthesis an X-ray of the lower back will need to be taken. This image can show the positioning of the vertebra as well as the possible presence of a fracture in the bone. If a crack is present, but the vertebra has not shifted, the patient can be diagnosed with spondylolysis. If the fracture has also caused a shift, the patient may be diagnosed with spondylolisthesis.

Treatment – There are both surgical and nonsurgical treatment options for these two conditions that depend largely on their severity. Nonsurgical plans will typically involve the patient taking time off of any sports or physical activity that likely contributed to the injury. Physicians might also suggest the patient wear a back-brace or attend physical therapy as part of their nonsurgical recovery plan. 

In more serious cases of spondylolysis and spondylolisthesis — namely, if the fracture has caused a serious shift in the vertebra or if an already present shift has become gradually worse — physicians will recommend a surgical recovery plan. Surgical treatments may include a spinal fusion of the lumbar vertebra and the sacrum, or the insertion of an internal brace of screws and rods used to hold together the vertebra as the fusion heals.

If your child or adolescent is experiencing back pain it is important to visit a board-certified orthopaedic physician as soon as possible to avoid worsening conditions.

Howard A. McMahan, M.D. is a board-certified orthopaedic surgeon. His areas of expertise include spine surgery, trauma, joint replacement, sports medicine and general orthopaedics. Dr. McMahan is in orthopaedic practice with Resurgens Orthopaedics – Midtown (550 Peachtree Street, 19th Floor). Additional information about Dr. McMahan can be found at www.resurgens.com.