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arch; or the fibrous bands that extend between the edges of the injury may never fully calcify. Any of these outcomes allows the vertebral body to slip forward, which distinguishes spondylolisthesis from spondylolysis. When it occurs in adolescents and young adults, spondylolisthesis is often associated with activities that involve repetitive twisting and back extension. Gymnasts, wrestlers, rowers, weight lifters, tennis players, and football players have a particularly high risk. TYPES OF SPONDYLOLISTHESIS Several types of spondylolisthesis have been identified, but the most common versions are called isthmic spondylolisthesis and degenerative spondylolisthesis. The isthmic version involves an inherent weakness at the pars interarticularis. This may be silent until a growth spurt—especially combined with athletic activities—causes multiple microfractures at the pars, which leads to pain and loss of range of motion. By contrast, degenerative spondylolisthesis affects adults mostly aged 40 and older. It doesn't always involve a structural problem at the vertebral arch. Instead, age- associated disc thinning, along with ligamentous changes associated with spondylosis, allow the lumbar facet joints to destabilize and the joint capsules to stretch as the affected vertebrae shift forward. SPONDYLOLISTHESIS SIGNS AND SYMPTOMS Signs and symptoms of spondylolisthesis generally correspond to the severity of the vertebral displacement. Slippages that are under 50 percent are by far the most common, and they are associated with central low-back pain, tight hamstrings, spasm of the lumbar paraspinal muscles, and, in some cases, Facet Joint Pars Interarticularis The pars interarticularis is a structural weak spot and the site of vulnerability in both spondylolysis and spondylolisthesis. pain that radiates into the buttock and thighs. Pain is worse with activity, especially weight bearing. More severe cases may demonstrate a palpable shelf in the lumbar spine when the patient flexes the trunk. Nerve compression is more likely in this situation, which may result in pain, numbness, or weakness along the affected dermatomes. Rarely, the damage to the spine may result in pressure directly on the spinal cord, which leads to an emergency situation called cauda equina syndrome. This can cause permanent loss of bladder and bowel control, as well as other complications, so it is important to deal with this as quickly as possible. One problem with degenerative spondylolisthesis is that it often has a slow onset, and it affects a population (people aged 40 and over) who may be at risk for other conditions that create a similar picture. The radiating pain and numbness that sometimes is seen with spondylolisthesis can easily be confused with symptoms of peripheral artery disease or peripheral neuropathy, and vice versa. These symptoms must be explored in order to be sure of their origin. TREATMENT FOR SPONDY CONDITIONS Except in very extreme cases, the structural problems that accompany these conditions are not worth trying to correct surgically. Consequently, they are considered an ongoing health issue that can be managed, but probably not reversed. The majority of cases of spondylosis, spondylolysis, and spondylolisthesis can be treated with mild pain relievers, exercise to strengthen the abdominal muscles, and massage to ease back pain and other symptoms. A client with an acute stress fracture may be counseled to use a back brace to help stabilize the vertebrae earn CE hours at your convenience: abmp's online education center, www.abmp.com 101