Spondylolysis is the most common cause of lower back pain in adolescent athletes. It is a vertebral stress fracture, most commonly occurring in the L4 or L5 vertebrae. If the stress fracture weakens the bone so much that it becomes unstable and the vertebra starts to slip out of place, then the condition is known as spondylolisthesis. In addition to sports injuries, spondylolisthesis occurs in women over the age of 40 as a result of degenerative disk disease. While sports injuries often cause the injury, it is thought that there may be a genetic predisposition to being susceptible to the stress fracture. The pain associated with these conditions usually feels like muscle strain of the lower back. In addition, spondylolisthesis can also cause back and hamstring muscle spasms that could affect posture. The doctor may need to perform X-rays, MRI, or CT scans to make a definitive diagnosis.
Rest, stretching, and anti-inflammatory drugs (aspirin or ibuprofen) are the typical first line of treatments for these conditions. Physical therapy, a back brace, or epidural steroid injections may also help reduce the pain and aid recovery.
If slippage and/or pain continue, then surgery may be necessary. The need for surgery is most commonly associated with spondylolisthesis caused by degenerative disk disease. The surgeon will usually do both a laminectomy (to remove the bone that is causing the compression) and a spinal fusion (see section on lower back surgery).