Does your Child
have low back pain?
Many children
complain of low back pain and this should never be shrugged off as ‘growing
pains’ or a ‘nothing’ to worry about they will ’outgrow’ it or it will go away.
The most common low back complaint in children is a spondylolysis, which may
lead to spondylolisthesis.
Often when we
are taking a history on an adult patient we discover that many have had the
issue and low back pain since childhood or even adolescence. Often when we do
an exam and a plain film x-ray we discover that there is a pars defect in the
low back vertebra causing a spondylolysis and sometimes a spondylolisthesis
(slippage). There is now new research to show that often this defect cannot be
found on plain x-ray and a MRI is needed to discover a ‘pending
spondylolisthesis’ – which is basically a stress fracture on the pars
interarticularis of the vertebra.
The most common
cause of low back pain in children and adolescents that can be seen on X-ray is
a stress fracture in one of the bones (vertebrae) that make up the spinal
column. Technically, this condition is called spondylolysis
(spon-dee-low-lye-sis). It usually affects the fifth lumbar l5 vertebra in the
lower back and, much less commonly, the fourth lumbar vertebra L4.
If the stress
fracture weakens the bone so much that it is unable to maintain its proper
position, the vertebra can start to shift out of place. This condition is
called spondylolisthesis (spon-dee-low-lis-thee-sis). Growth plays a definite
role in the cause of spondylolysis and has a strong prevalence in age 14-
younger in females from the earlier adolescent growth. This factor explains the
prominence of slippage in girls (listhesis) and more pars defect in boys
(lysis). Often congenital defects found on x-ray such as facet orientation,
occult spina bifida and/or a longer pars have a higher relevance of
spondylolisthesis. Spondylolisthesis can also be caused by a traumatic event
such as a bad fall or hit playing sports or otherwise. Often we do not know the
specific incident that causes and spondylolysis/listhesis in children and
adults.
Treatment for a
childhood spondylolisthesis includes chiropractic adjustments to approximate
the pars defect, pelvic tilt exercises, as well as possible rehab with a Boston
Brace. The Boston Brace holds the pelvis in a pelvic tilt- helping to
approximate the pars defect, allow healing in the correct position. Often the
brace is recommended for 3-4 months duration. If you suspect this issue in your
child get them checked by your chiropractor.
Dr. Joelle Johnson
has been a member of the International Chiropractic Pediatric Association for
15 years and has treated many children for low back pain and complaints. She is
located at 142 Erickson Drive, Red Deer. T4R 2C3
www.family1stchiro.ca 403-347-3261
http://www.theamericanchiropractor.com/articles-radiology/8733-pending-spondylolysis-andor-spondylolisthesis-whats-it-all-mean.html
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