Child Orthopedics

Frequently Asked Questions

Our twelve-year old daughter has a back problem called spondylolisthesis. She's done everything the doctor has told her to do faithfully. She still has back pain that keeps her in bed somedays. Surgery may be the next step. How do we decide?

Spondylolisthesis is a condition in which a fracture of the pars interarticularis separates. The pars interarticularis is part of the bony ring that surrounds the spinal cord. It forms part of the supporting spinal column. When displacement of the bone occurs, the body of the vertebra moves forward over the bone below it.

If caught early enough, this condition can be treated with bracing, rest or activity modification, and specific exercises. When pain persists despite this conservative treatment, then surgery may be the next step. A minimum of six months of nonsurgical treatment is advised.

Other reasons to consider surgery include: worsening of the bone position or neurologic symptoms that get worse instead of better. This could be numbness and tingling down the leg. It could even cause changes in bowel or bladder function.

The orthopedic specialist will help you make this decision. Repeated X-rays and CT scans taken over time will show the progression of the spondylolisthesis. If bony healing doesn't occur and the vertebra continues to slip forward, then it may be time to consider surgery.

Ralph Cavalier, MD et al. Spondylolysis and Spondylolisthesis in Children and Adolescents: I. Diagnosis, Natural History, and Nonsurgical Management. In Journal of the American Academy of Orthopaedic Surgeons. July 2006. Vol. 14. No. 7. Pp. 417-424.

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