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Common Cause of Low Back Pain in Children

Spondylolysis is a common cause of low back pain in children. This is a defect or tiny fracture in the supporting column of the vertebra. If the fracture line separates and the bone moves forward, then the condition is called spondylolisthesis. Back pain and tight hamstrings are typical symptoms with either condition.

In this article, orthopedic surgeons from several well-known clinics and hospitals give a review of spondylolysis and spondylolisthesis. It's rarely reported in children under the age of six. The lumbar spine at L5 is affected most often. The person is more likely to have symptoms when the problem is at L4. In young children and teenagers, spondylolisthesis occurs most often at the L5-S1 segment.

Sports activities increase the risk of developing spondylolysis. Extending the spine too far and too often (hyperextension) combined with rotation such as occur in diving and gymnastics can lead to spondylolysis. Sometimes it's congenital with changes in bone formation present at birth.

Spondylolisthesis can be grouped or classified as one of five types based on cause as determined by X-ray findings. A second classification system divides cases into two broad groups. The first is developmental (occurs as a result of trauma or fatigue failure) from repetitive use. The second is acquired at birth from an inherited deformity.

The authors report that conservative care is the gold standard for spondylotic stress fractures. The tiny fracture has a chance of healing. A back brace, activity restriction, and physical therapy are advised until CT scan shows bone healing. Return to full activities is possible.

Surgery may be needed if the painful symptoms don't go away after six months of conservative care. Neurologic changes can become permanent if not taken care of surgically. When pain persists, spinal fusion to stabilize the displaced vertebra may be the best treatment.

References: 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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