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A fracture or crack of the vertebral arch in the lower lumbar spine is called spondylolysis. It may happen either suddenly or gradually as the culmination of a series of repeated strains – rather like a fatigue fracture in metal; or as a result of a congenital defect. It often causes no symptoms and a person may have it all his life without knowing.

Spondylolisthesis-This is a condition in which a vertebra slips forward out of alignment with the part of the spine below it. It commonly arises in the fourth or the fifth lumbar vertebra, so that all the rest of the spine moves forward out of line with the sacrum. The usual cause is a defect or crack of the neural arch (spondylolysis), which causes the facet joints of the articular processes, which normally hold the vertebrae in line, to loosen their hold.

Much less commonly, the slippage may be in a backwards direction; it is then called retrolisthesis.

The causes of the trouble may come from a hereditary weakness of the neural arch: it seems to run in some families and some races, being common among Eskimos. It may, however arise from injury, such as a heavy fall on to one’s behind; or from constant stress, as in the case of athletes and gymnasts; or simply from wear and tear in middle age.

In spondylolisthesis the damage, unlike many vertebral fractures, does not heal spontaneously, perhaps because the lumbar spine has a natural forward curve.

There may be severe pain, if deformation of the neural arch or the displacement of a vertebral body causes pressure on a nerve; if the slippage damages the disc fibres and brings about a prolapse, or if it causes repetitive stress on adjacent ligaments and muscles.

Cumulative damage-However, most damage to the bones of the spine is cumulative. The spine is a symmetrical structure, and can be damaged by stress that is unequally distributed. When the vertebral bodies are continually made to bear uneven stresses by being loaded more heavily on one side than on the other, wear and tear causes irregular shaping of the bone material.


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