- See:
Back Pain in Children
- Discussion:
- results of exam may be normal in child w/ spondylolysis or mild (
Grade-I
or
Grade-II) spondylolisthesis.
- Back:
- tenderness to palpation in the low back;
- splinting as well as guarding & restriction of side-to-side motion of low back, particularly if onset of symptoms is acute;
- lumbar offset & lordosis may be severe, & they are usually accompanied by backward tilt of
pelvis that may result from tight hamstrings;
- when viewed from back, ilia appear flared & buttocks are heart-shaped and flattened;
- distortion of pelvis & trunk begin to become clinically apparent in late stages
of
Grade-II spondylolysis & is usually present when
slip reaches
Grade III;
- cephalad to 5th lumbar spinous process, there may be palpable step-off or depression, which is prominent
while 4th lumbar spinous process is carried forward w/ anterior displacement of vertebral bodies;
- Tight Hamstrings:
- restricted flexion of hips due to tight hamstrings may be the only finding;
- 80% of symptomatic pts have tight hamstrings;
- tight hamstrings may be found in pts who have spondylolysis or any grade of spondylolisthesis;
- tightness may be extreme, so that child cannot bend forward at hips or, during straight leg-raising test,
examiner cannot lift foot more than a few cm from the examining table;
- Gait:
- tight hamstrings cause peculiar gait (pelvic waddle) in children w/
Spondylolisthesis;
- excessively tight hamstring muscles tilt the pelvis backward and do not permit the hip to flex sufficiently for a normal stride;
- consequently, pt has stiff-legged & short-stride gait, & pelvis rotates with each step.
- child may prefer to jog or run rather than walk, or to walk on the toes with the knees bent;
- Abdomen:
- when viewed from front, lower part of pt's abdomen appears to be thrust forward, forming
transverse abdominal crease at level of umbilicus.
- Neurologic Findings: neurologic deficits are uncommon;
- most often involves the L5 nerve root;
- L5 neuroforamen is narrowed anteriorly and inferiorly by the S1 vertebral body, posteriorly
by the L5 pedicle, and dorsally by the fibrous tissue around the L5 pars defect;
