While the five distinct bone group categories—thoracic, cervical, lumbar, sacrum and coccyx—work together to allow the body to remain in an upright position, the effects of age and a lifetime of stress on the vertebrae can damage the structure of these bones and, as a result, of the spine itself. And when this occurs, a condition known as spondylosis is diagnosed and categorized into one of three types. Cervical spondylosis affects the bones in the neck; thoracic spondylosis the bones that make up the chest wall; and lumbar spondylosis the bones of the lower back

Likewise, occasionally one of the 33 bones that comprise the spine “slips” out of position and moves forward onto the vertebra that lies next to it, resulting in a condition known as spondylolisthesis. Back and leg pain often ensues from this condition, which is believed to be caused most often from undue stress and strain being placed on the spine or from a deterioration of a part of the spine itself. And once spondylolisthesis is present, the lower spine can become abnormally shaped and the vertebral canal can become significantly narrowed. Generally, a diagnosis of spondylolisthesis classifies the severity of the condition by assessing the percent of slippage and assigning it a grade from one to five.

With spondylolysis, symptoms vary depending on which of the three areas of the spine is affected. For instance, those suffering from cervical (neck) spondylosis experience numbness in their fingers and changes in muscle tone in their arms and hands, possibly accompanied by some degree of pain. Those who develop spondylosis in their lower back (lumbar) will have pain moving down their legs and into their feet, along with changes in sensation. Adolescents suffering from this condition need to maintain strong core muscle strength to support their lower backs, and should avoid activities that could cause injury to this area.

Unlike spondylolysis, for the majority of adolescents with spondylolisthesis their condition is undiagnosed as they are not experiencing any initial signs or symptoms, However, as spondylolisthesis progresses pain in the legs, accompanied by tingling and weakness, can develop and become a serious problem.

Treatments for spondylolysis and spondylolisthesis include both non-surgical and surgical options. The former focuses on managing and reducing painful symptoms, promoting healing in existing fractures and preventing future vertebral slippages. In fact, in many cases rest, pain- and inflammation-reducing medications and a cessation of certain activities—combined with consistent medical observation—are enough to remedy the symptoms of these conditions. In certain circumstances some form of bracing device may be recommended in the event of fracture, and physical therapy can be useful to improve muscle strength and flexibility. In fact, some 80 percent of adolescents suffering from spondylolysis will require non-surgical treatments only.

Surgical intervention for spondylolysis is rare. However, for spondylolisthesis it may be necessary if symptoms of pain and a loss of range of movement occurs or if the case is classified as a grade 3 or higher (representing a more than 50 percent slippage of bone). The goal of any surgery for the treatment of pediatric or adolescent spondylolisthesis will be to reduce or eliminate pain, realign the vertebrae to a normal position and promote stabilization of the spine to prevent a progression of the condition and further symptoms. And such a surgery would typically take the form of a spinal decompression procedure through the removal of bone as well as fusion techniques, both of which allow for a relief of nerve compression.