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Q My 15-year-old son plays hockey and soccer and has just been diagnosed with spondylolisthesis minimal slip by a bone scan The doctor said this was caused by overuse Currently my son has lower back pain no leg pain A Spondylolisthesis is a forward or backward slippage of one vertebra spinal bone upon another Based upon your information I assume that your sons problem is in the lumbar spine low back Please keep in mind that without an actual physical examination I cannot provide more than general information The vertebrae are held in alignment by a number of different structures including the intervertebral discs tough fibrous ligaments and small joints at the outer rear of the spine called facet joints All of these structures handle tremendous forces particularly in the lumbar spine and particularly in persons involved in vigorous sports activities such as hockey or gymnastics In teenagers spondylolisthesis most often occurs when a bony structure called the Pars Interarticularis which bridges one facet joint to another fractures under stress This allows the affected vertebra to slide forward in relation to the others causing pain Pain is usually worse with any attempt to bend backward extend the spine and improves with leaning forward flexion Par fractures often show up on plain X-rays but where they are not obvious on X-ray they usually show up on a bone scan For the young patient with spondylolisthesis we usually recommend a carefully prescribed program of rehabilitation usually starting with physical therapy to teach an appropriate exercise program Exercises focus on improving posture strengthening postural muscles such as the abdominals and improving flexibility Sometimes a lumbar support or brace is needed early in the course of treatment The Pars fracture may heal in many cases it does not but ceases to become painful Most young people with this problem do quite well with appropriate treatment A physiatrist rehabilitation specialist or other physician
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