Whether or not to undergo spine surgery for isthmic spondylolisthesis is a very good question. When a patient has a stress fracture in the spine (spondylolysis) which is bilateral, and then one vertebral body slips on the one below, that is termed isthmic spondylolisthesis. As soon as the beginning stress fracture happens, termed spondylolysis, the individual will often experience pain, however, surgery for spondylolysis itself is typically not a good idea.

Surgery could be necessary in unusual circumstances for spondylolysis, however, typically it is dealt with effectively with conservative management. If the fracture doesn't heal but died out after trying, then what you can end up with is the vertebral body slipping forward as the back part of the spinal level stays put and what you end up with is one vertebral body slipping forward over the one below it, which is called spondylolisthesis.

In order to see whether surgery is indicated for spondylolisthesis, a decision needs to be made as to the slippage degree. A Grade 1 slip means the vertebral body slips between 0 and 25% compared to the vertebral body below it. A Grade Two Slip is defined as a vertebral body slipping forward 25 to 50% of the length is 75 to 100% of one vertebral body over the bottom one. A Grade Five is over 100%, and this is actually called spondyloptosis.

Research studies have shown by the time an individual is seen with spondylolisthesis that is symptomatic, the person's slip has achieved ninety percent of that it will ever slip. Studies of isthmic spondylolisthesis also show that surgery is indicated for slips that are over a Grade Two. So if it's a Grade Three or Grade Four then surgery is indicated in order to alleviate the patient symptoms and prevent further slippage from occurring.

Whether or not to reduce the slip during surgery is controversial, however, what's not controversial is that the levels should be fused and the nerve roots being pulled should be decompressed.

If a patient has a Grade One or Grade Two slip, then surgery is indicated only if conservative AZ pain management treatment fails. This could include physical therapy, phoenix chiropractor treatment, spinal bracing, TENS machines, and pain management.

The term spondylolysis refers to a fracture of a vertebral body. The initial part "spondylo" means spine, and the latter part "lysis" means fracture. Spondylolysis results from repetitive trauma to the spine that results in a stress fracture. The repetitive trauma to the vertebral body comes from activities that involve hyperextension. An example of this activity would be a football lineman who over and over again moves from a position where he's on all fours up to a hyperextended position with his back in order to defend the football line. Other common activities that end up with spondylolysis are gymnnastics, rowing, and cheerleading. The usual age ranges for spondylolysis are the teen years and heading into college age.

The diagnosis is made from a combination of:

1. Physical examination and history
2. Imaging studies such as x-rays and MRIs or maybe a CAT scan.
3. Potentially a bone scan

It may be necessary to obtain a bone scan (dexa scan) as the exam and imaging studies may not definitively show the fracture. There is one particular view that is an oblique x-ray of the lumbar spine that is the best for seeing the fracture. The finding of where the fracture is seen is referred to as the "Scotty Dog" view and one can see a line across the "neck of the Scotty Dog" which is the anatomical area known as the pars interarticularis. A significant amount of people call it a "pars fracture"."

In order to see if the spondylolysis is actively trying to heal the bone scan may help there too. If it lights up on a bone scan the you know that the patient's bone is actively trying to heal itself. The area that is undergoing a stress fracture is called the pars interarticularis.

Treatment for spondylolysis involves activity restrictions and bracing and potentially phoenix physical therapy. If the patient is a football player football should be restricted for a time period to allow the fracture the ability to heal. This can be significantly different for players attempting to become upper level athletes being restricted from the spondylolysis pain.

On top of that now you tell that patient not to compete in his or her chosen field of expertise. So treatment conformity may be difficult in this population. On top of lumbar bracing and activity restrictions, the individual may be given anti-inflammatory medications along with Tylenol for pain alleviation.Treatment with an Arizona Pain Doctors may provide substantial benefit for the spondylolysis patient.

One of the ways to see if the fracture has healed is first and foremost if the patient's pain is alleviated, but also the bone scan can be repeated see if it no longer "lights up". If the fracture has healed, there will be no uptake into the fracture area of the injected material as it attaches to bone that is healing only.

Unfortunately there's no guarantee that the spondylolysis fracture pain will not come back even if treatment is successful the first time with Arizona Pain Managment. Therefore it is necessary to be aware that the pain may come back and not to go back too soon to the high level activities but to gradually work one's way back up into those levels.