Spondylolisthesis is a stress fracture that happens to young athletes who put a lot of stress on the lower back. It can be debilitating when one vertebra slips onto another.
But less invasive back surgery and more precise tools are making surgery safer and improving outcomes.
Twelve-year-old Kaleigh Clemons practiced gymnastics beginning at age 5.
"I could do back handsprings all over the yard, I practiced all the time," she said.
But she developed severe back pain and was finally diagnosed with spondylolisthesis, a spinal deformity made worse by extreme physical stress.
"She was looking at a very difficult life ahead of her with back pain and leg pain if this was left untreated," orthopedic surgeon Dr. Isador Lieberman said.
"He looked me square in the face and he told me, 'She's going to dance again,'" said Mark Clemons, Kaleigh's father.
Now, just four months after surgery, Kaleigh is dancing, regaining her balance and lifting weights, and she is 2 1/2 inches taller.
"This is the ultrasonic bone scalpel, as one of my former fellows said, this is the game changer," Lieberman said.
The ultrasonic bone scalpel vibrates 22,500 times per second to precisely cut bone, but the tip is not sharp and bounces off soft tissue, so it is a safer, less intrusive way of doing spinal surgery.
"I can't believe where I am now," Kaleigh said.
"In January, we were facing a wheelchair, diapers, all those things that go through our heads, to now where she's riding her bike," said Cassey Clemons, Kaleigh's mother.
Lieberman says when Kaleigh's back heals completely, she would be able to resume gymnastics if she wanted.
TOPIC: BONE SCALPEL GETS KALEIGH BACK IN THE GROOVE
REPORT: MB #4609
BACKGROUND: Spondylolysis and spondylolisthesis are common causes of low back pain in young athletes. Spondylolysis is a crack or stress fracture in one of the vertebrae, the small bones that make up the spinal column. If left untreated, spondylolysis can weaken the vertebra so much that it is unable to maintain its proper position in the spine. This condition is called spondylolisthesis. In spondylolisthesis, the fractured pars interarticularis separates, allowing the injured vertebra to shift or slip forward on the vertebra directly below it. In children and adolescents, this slippage most often occurs during periods of rapid growth—such as an adolescent growth spurt. Doctors commonly describe spondylolisthesis as either low grade or high grade, depending upon the amount of slippage. A high-grade slip occurs when more than 50 percent of the width of the fractured vertebra slips forward on the vertebra below it. Patients with high-grade slips are more likely to experience significant pain and nerve injury and to need surgery to relieve their symptoms. (Source: https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis)
TREATMENT: Initial treatment is almost always nonsurgical in nature. Most patients with spondylolysis and low-grade spondylolisthesis will improve with nonsurgical treatment. Surgery may be recommended for spondylolisthesis patients who have severe or high-grade slippage, slippage that is progressively worsening, or back pain that has not improved after a period of nonsurgical treatment. Spinal fusion between the fifth lumbar vertebra and the sacrum is the surgical procedure most often used to treat patients with spondylolisthesis. Spinal fusion is essentially a "welding" process. The basic idea is to fuse together the affected vertebrae so that they heal into a single, solid bone. Fusion eliminates motion between the damaged vertebrae and takes away some spinal flexibility. The theory is that, if the painful spine segment does not move, it should not hurt. (Source: https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis)
NEW TECHNOLOGY: The ultrasonic BoneScalpel is a tissue-specific device that allows the surgeon to make precise osteotomies while protecting collateral or adjacent soft tissue structures. The device is comprised of a blunt ultrasonic blade that oscillates at over 22,500 cycles per second with an imperceptible microscopic amplitude. The recurring impacts pulverize the noncompliant crystalline structure resulting in a precise cut. The more compliant adjacent soft tissue is not affected by the ultrasonic oscillation. If used properly, this device may decrease the risk of soft tissue injury associated with the use of high- speed burrs and oscillating saws during spine surgery. (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843782/)