Other Adolescent Spine/Back Conditions

Why does my back hurt?

More than half of all adolescents experience back pain. In most cases growing pains and muscle strains are the culprit, both of which get better if you do stretching exercises and give it a little time. You can also take ibuprofen or acetaminophen.

If your pain persists for a few months, you need to visit your doctor. A simple examination, and possibly a few x-rays, will help rule out conditions other than growing pains and muscle strains.

What is kyphosis?

During adolescence, developmental kyphosis—a larger-than-normal forward bend in the thoracic spine in the upper back—can arise. It frequently remains mild and requires only periodic x-rays. In rare instances, patients have spinal fusion surgery to straighten the spine. Two forms seen in adolescents are:

• Postural kyphosis can be corrected when a patient attempts to stand up straight because the vertebrae have no abnormalities in shape.
• Scheuermann’s kyphosis typically develops during the time of heavy adolescent bone growth: age 12 to 15 in boys or a few years earlier in girls; the back is stiff due to the abnormal shape of the vertebrae. The front sections of the vertebrae grow slower than the back sections. In addition to poor posture, kids often have back pain if the apex (most angular section) is in the mid-to-low back instead of the upper back. This is most common in the earlier teenage years but typically improves with time, and the pain rarely interferes with activities.

To learn more about Kyphosis, visit the Kyphosis page under Conditions & Treatments. 

What Is Spondylolysis?

Spondylolysis results when cracks or fractures occur in the pars interarticularis, the portion of the lumbar spine that joins the upper and lower joints together of a single vertebra (individual bone in the spine). Spondylolysis is the middle of 3 stages of injury to the pars interarticularis, with the first (least serious) being a stress reaction and the third (most serious) being actual slippage of vertebra(e) (spondylolisthesis).

Who is most prone?

• Children 8 years and older. In the vast majority of children, the pars interarticularis is normal. But certain patients begin to experience abnormal growth and development in the pars interarticularis, usually after 8 years of age.
• Gymnasts and heavy weightlifter activities, which perform excessive wear and tear, are particularly culpable aggravators of spondylolysis symptoms.
• Alaskan Indians are prone to spondylolysis due to a genetic weakness to the bone.

Symptoms

As with any spine condition, symptoms can vary from patient to patient but generally include the following:

• Persistent lower back pain
• Stiffness in the back or legs
• Hamstring muscle tightness.

Diagnostics

X-ray imaging typically confirms bony abnormality. However, with a stress reaction, an x-ray may not reveal any abnormality.

Treatment

The goals of treatment include relieving pain, decreasing acute spasm, and restoring spinal flexibility. The prognosis is affected by slippage of one vertebra on another (spondylolisthesis). In general, most patients with less than 50% slippage tend to fare well through adolescence. With slippage of 50% or greater, the potential for additional slippage with growth and aging is greater.

Nonoperative Treatment:

Most spondylolysis patients will respond well to nonoperative medical management as prescribed by your physician, such as:

• Anti-inflammatory drugs
• Brace wear
• Activity modifications
• Physical therapy treatment that incorporates truncal core strengthening exercises (the therapist will caution the patient on avoiding hyperextension maneuvers and excessive abdominal "crunches"). Post-treatment "maintenance" exercises like truncal core muscle strengthening (Pilates or yoga) may be prescribed to condition the muscles and minimize re-injury.

Operative Treatment

If the pain, spasm, or slippage increases despite conservative management, then the surgeon may recommend various options:

1) Spinal fusion. For a majority of children and adults, fusing the fifth lumbar vertebra to the sacrum (the most common vertebrae involved in adolescents with spondylolisthesis) is the preferred surgical option.

• The fusion involves removing the loose bony fragments and placing bone graft that will lead to the 2 vertebrae "fusing together" to prevent any further slippage. Specially designed screws and rods may be needed to hold the vertebrae in place to help the two bones fuse together.
• A perforated, hollow cylinder called a "cage" is sometimes required. The "cage" is filled with bone matter and placed in the disc space between the two vertebrae to increase the likelihood of fusion.
• Bones may be realigned depending on how much one vertebra has slipped forward on the other. The most important steps are restoring stability and making sure the nerves have no pressure on them.

2) Pars repair. At times the pars fracture can be repaired without fusing 2 vertebrae together. This involves removing any scar material that may have developed in the fracture site of a single vertebra, and stabilizing the 2 sides of the fracture to restore normal anatomy.

What is Spondylolisthesis?

Isthmic spondylolisthesis results when a fracture gap at the pars interarticularis (the junction of the upper and lower lumbar spine joints of one vertebra) widens. Widening of the gap leads to the fifth lumbar vertebra shifting forward on the part of the pelvic bone called the sacrum; this is known as "slippage."

Symptoms

The primary symptom of spondylolisthesis is pain, much of it related to nerve root irritation. Pain can occur in the lower back, buttocks, or legs. Numbness or a tingling sensation of the legs can also be a symptom of spondylolisthesis.

Treatment

Nonoperative Treatment

May include one or more of the following as prescribed by your physician:

• Anti-inflammatory drugs
• Brace wear
• Activity modifications
• Physical therapy treatment that incorporates truncal core strengthening exercises (The therapist will caution the patient on avoiding hyperextension maneuvers and excessive abdominal "crunches"). Post-treatment "maintenance" exercises like truncal core muscle strengthening (Pilates or yoga) may be prescribed to condition the muscles and minimize re-injury.

Operative Treatment

If the pain, spasm, or slippage increases despite conservative management, then the surgeon may discuss several potential surgical options with the patient, the most common being spinal fusion: fusing the fifth lumbar vertebra to the sacrum (the most common vertebrae involved in adolescents with spondylolisthesis). The fusion involves removing the loose bony fragments and placing bone graft that will lead to the 2 vertebrae "fusing together" to prevent any further slippage. Specially designed screws and rods may be needed to hold the vertebrae in place to help the two bones fuse together. Also, a perforated, hollow cylinder called a "cage" is sometimes required. The "cage" is filled with bone matter and placed in the disc space between the two vertebrae to increase the likelihood of fusion.

Bones may be realigned depending on how much one vertebra has slipped forward on the other. The most important steps are restoring stability and making sure the nerves have no pressure on them.