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90 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 9 technique CLINICAL EXPLORATIONS Spondylolysis and Spondylolisthesis A Slippery Slope with Back Disorders By Whitney Lowe arch takes on a greater compressive load. Repeated compressive loading of the posterior arch can cause small stress fractures to develop in the region of the pars. These small fractures are spondylolysis. Structural weakness in the pars is estimated to occur in about 6 percent of the population. 1 If those stress fractures progress, a larger fracture develops and the body of the vertebra may separate from the posterior vertebral arch structures. When it separates, there is a tendency for the vertebra to move in an anterior direction because of the lumbar lordosis. The sliding of the vertebral body is spondylolisthesis. Anterior sliding of the vertebra is most common and is often called anterolisthesis. Vertebrae may slide in other directions, but this is rare. The vast majority of spondylolisthesis cases occur with the L5 vertebra sliding anteriorly on the sacrum. Biomechanics plays a key role in the forward slippage of the vertebra, but it is not the only factor. The different classification systems described on page 91 indicate other factors, such as genetics, that can also play a major role in these conditions' development. 1 Massage therapy has consistently demonstrated benefit for numerous muscular back pain conditions. Sometimes, though, there can be more serious underlying structural issues causing pain and limited movement. In this issue, we examine two common conditions, spondylolysis and spondylolisthesis, that massage therapists should be familiar with to provide appropriate care. These conditions admittedly have names that are tongue twisters. Let's look how the names actually help us better understand the conditions. Spondyl- refers to the spine and -lysis refers to breaking down or disintegrating, while -listhesis means sliding down a slope, which is essentially what is happening to the lumbar vertebrae in this condition. Now, let's explore the spinal structure and function that help illustrate these two conditions. ANATOMICAL AND BIOMECHANICAL CONSIDERATIONS Both spondylolysis and spondylolisthesis are conditions involving structural breakdown of the vertebrae, most commonly in the lumbar spine. Both conditions' severity lies on a continuum. Spondylolysis often develops into spondylolisthesis if it is not properly treated. In both cases, the primary problem involves the posterior arch of the vertebrae. The bodies of the lumbar vertebrae bear most of the responsibility for distributing the lumbar spine's compressive load (Image 1). Under normal conditions, the line of compressive force travels mostly through the lumbar vertebrae and intervertebral disk. However, when the spine is in greater extension (such as an exaggerated lordosis), the line of force for compressive load on the spine moves posteriorly and the posterior vertebral arch structures carry greater weight. Activities like gymnastics that involve extensive spinal extension often predispose participants to damaging compressive stress on the posterior arch structures (Image 2). Other sporting activities that frequently produce similar compressive loads on the posterior arch structures include football, wrestling, and weight lifting. Various occupational activities may also cause similar biomechanical stresses on the posterior vertebral arch. The region between the superior and inferior articular facets of the vertebrae is called the pars interarticularis (or pars for short). The pars is an area of structural weakness when the posterior vertebral Bodies of the lumbar vertebrae carry most of the compressive load. Image is from 3D4Medical's Complete Anatomy application.