Don’t think that back pain is the preserve of middle-aged and older people; teenagers can have back pain too. What are the possibilities of low back pain in teenagers? According to experts, the first thing to rule out is ankylosing crestitis, followed by isthmic spondylolisthesis and lumbar spinal tuberculosis. Why do you have an isthmic spondylolisthesis? An isthmic spondylolisthesis is a developmental defect of the vertebral arch, which is a potential cause of crestal spondylolisthesis. This underlying factor occurs between the lumbosacral region, where the sacral facets and articular processes are hypoplastic, causing severe forward slippage, often with cauda equina symptoms. Lumbar arch cleft is mostly seen in young people with an incidence of about 3% to 6%, although studies have reported that it is often associated with previous trauma to the patient and has a higher incidence in the athlete population than in the general population, but the exact etiology is still unknown. Most scholars believe that it is a fatigue fracture caused by repetitive injury or long-term uneven force. The heavy schoolwork, heavy school bags, and incorrect posture of today’s adolescents are all predisposing factors. In addition, the disease has congenital factors, including dysplasia of the vertebral arch, which is a discontinuity of the vertebral arch due to an impairment of the ossification process, with a clear family history and heredity. The main pathological manifestation is crestal interarticular cartilage dysplasia, which occurs mostly in the 5th lumbar vertebra and to a lesser extent in the 4th lumbar vertebra. There are fibrous tissue connections in the divided spaces. The “isthmuscle” itself is not a cause for concern. The “isthmuscle” itself is not a cause for concern, but if it is not treated properly, it can gradually develop into a slipped vertebral body, resulting in compression of the crestal medulla and even paralysis, with serious consequences. In adolescents, if there are no symptoms, there is usually no need for treatment and only follow-up is needed. For patients with symptoms, first of all, they should be given conventional treatment to reduce pain, restrict activities, rest, wear braces, physical therapy, etc. After a period of time, they should perform appropriate exercises, such as swimming, jogging, and “swallow flying” to strengthen the muscles of the low back; special attention should be paid to avoid bending over and lifting heavy objects, throwing solid balls, etc. These exercises are likely to cause vertebral slippage and even paralysis. These exercises are likely to cause vertebral body slippage, thus aggravating the condition. The clinical manifestations of this disease can be divided into the following cases: true crestal slippage, i.e., slippage due to bone discontinuity in the isthmus of the vertebral arch, which is the most common; pseudo-cristal slippage, without bone discontinuity in the isthmus, due only to degenerative changes in the crestal vertebrae or intervertebral discs, or other causes of mild anterior displacement of the vertebral body, which is more common; and posterior slippage, which is less common. The common symptom of the above three kinds of slippage is chronic back and leg pain, and simple isthmus is not connected more than obvious clinical symptoms, but because of the poor stability of the lumbosacral area, local soft tissue is prone to strain. The main symptom is low back and leg pain, which is obvious in adulthood. The location and nature of the pain varies, and it can be continuous or intermittent, or it can be felt only during excessive exertion. The pain may be confined to the lumbosacral region, but may also radiate to the hip, sacrococcygeal region or lower extremities, such as sciatica, spinal stenosis, etc. For those who have cauda equina palsy, the pain is lighter after bed rest and increases when getting up from a recumbent position. There is occasional movement within the lumbar region when moving. In order to avoid lumbar spondylolisthesis, when adolescents have back pain, it is best not to take it lightly and go to the hospital for examination to exclude the above-mentioned diseases is more secure.