More than half of all adolescents experience back pain. In most cases growing pains and muscle strains are the culprit, both of which get better if you do stretching exercises and give it a little time. You can also take ibuprofen or acetaminophen.
If your pain persists for a few months, you need to visit your doctor. A simple examination, and possibly a few x-rays, will help rule out conditions other than growing pains and muscle strains.
During adolescence, developmental kyphosis—a larger-than-normal forward bend in the thoracic spine in the upper back—can arise. It frequently remains mild and requires only periodic x-rays. In rare instances, patients have spinal fusion surgery to straighten the spine. Two forms seen in adolescents are:
Spondylolysis results when cracks or fractures occur in the pars interarticularis, the portion of the lumbar spine that joins the upper and lower joints together of a single vertebra (individual bone in the spine). Spondylolysis is the middle of 3 stages of injury to the pars interarticularis, with the first (least serious) being a stress reaction and the third (most serious) being actual slippage of vertebra(e) (spondylolisthesis).
As with any spine condition or deformity, symptoms can vary from patient to patient but generally include the following:
X-ray imaging typically confirms bony abnormality. However, with a stress reaction, an x-ray may not reveal any abnormality.
The goals of treatment include relieving pain, decreasing acute spasm, and restoring spinal flexibility. The prognosis is affected by slippage of one vertebra on another (spondylolisthesis). In general, most patients with less than 50% slippage tend to fare well through adolescence. With slippage of 50% or greater, the potential for additional slippage with growth and aging is greater.
Most spondylolysis patients will respond well to nonoperative medical management as prescribed by your physician, such as:
If the pain, spasm, or slippage increases despite conservative management, then the surgeon may recommend various options:
1) Spinal fusion. For a majority of children and adults, fusing the fifth lumbar vertebra to the sacrum (the most common vertebrae involved in adolescents with spondylolisthesis) is the preferred surgical option.
2) Pars repair. At times the pars fracture can be repaired without fusing 2 vertebrae together. This involves removing any scar material that may have developed in the fracture site of a single vertebra, and stabilizing the 2 sides of the fracture to restore normal anatomy.
Isthmic spondylolisthesis results when a fracture gap at the pars interarticularis (the junction of the upper and lower lumbar spine joints of one vertebra) widens. Widening of the gap leads to the fifth lumbar vertebra shifting forward on the part of the pelvic bone called the sacrum; this is known as "slippage."
The primary symptom of spondylolisthesis is pain, much of it related to nerve root irritation. Pain can occur in the lower back, buttocks, or legs. Numbness or a tingling sensation of the legs can also be a symptom of spondylolisthesis.
May include one or more of the following as prescribed by your physician:
If the pain, spasm, or slippage increases despite conservative management, then the surgeon may discuss several potential surgical options with the patient, the most common being spinal fusion: fusing the fifth lumbar vertebra to the sacrum (the most common vertebrae involved in adolescents with spondylolisthesis). The fusion involves removing the loose bony fragments and placing bone graft that will lead to the 2 vertebrae "fusing together" to prevent any further slippage. Specially designed screws and rods may be needed to hold the vertebrae in place to help the two bones fuse together. Also, a perforated, hollow cylinder called a "cage" is sometimes required. The "cage" is filled with bone matter and placed in the disc space between the two vertebrae to increase the likelihood of fusion.
Bones may be realigned depending on how much one vertebra has slipped forward on the other. The most important steps are restoring stability and making sure the nerves have no pressure on them.