Spondylolisthesis is a condition that occurs when a lumbar vertebra slips out of place. The vertebra slides forward, and distorts the shape of the spine. This may compress the nerves in the spinal canal and the nerves that exit the foramen (open spaces on the sides of your vertebrae).
What You Need To Know About Spondylolisthesis
- What is Spondylolisthesis?
- What Causes Spondylolisthesis?
- Symptoms of Spondylolisthesis
- How is Spondylolisthesis Diagnosed?
- Treatment for Spondylolisthesis
What is Spondylolisthesis?
Spondylolisthesis is a condition that results in spinal instability. The pars interarticularis — a small bone segment that helps connect the facet joints — separates from the spine, causing the lumbar vertebra to slip out of place and onto the lower vertebra. Instability and motion from the vertebrae may pressure the surrounding nerves and cause lower back or leg pain.
Doctors rate the severity of the condition from low to high grade, depending on the amount of unstable slippage. Children and adolescents can develop spondylolisthesis during periods of rapid growth. Although some people may experience virtually no symptoms for years, 4-6% of adults have spondylolisthesis and spondylolysis. However, patients undergoing high-grade slips can endure chronic pain or nerve injury. Surgery may be required as a solution to debilitating symptoms.
These are several subtypes of spondylolisthesis, including:
Congenital spondylolisthesis happens when an infant's spine does not properly develop in the mother's womb. The vertebrae's misalignment can become more unstable as the infant matures, and the person will be more at risk for slippage later in life.
Isthmic spondylolisthesis occurs when one vertebra slips forward onto the one below it, causing a bone fracture that connects the spinal area's two joints. The fracture of the pars interarticularis, the bone connecting the top and lower facet joints, will cause the condition.
Degenerative spondylolisthesis is the most common type of spondylolisthesis and develops due to gradual aging. The disks that cushion the vertebrae progressively lose water and become thin, increasing the likelihood of slipping out of place.
Traumatic spondylolisthesis occurs due to trauma on the vertebrae causing it to slip.
Pathological spondylolisthesis is a rare type that results from damaged posterior elements of the spine. The condition may occur from a variety of causes, including tuberculosis, tumors, or osteoporosis.
Post-surgical spondylolisthesis emerges due to spinal surgery complications that cause slippage.
Spondylolisthesis vs. Spondylolysis
Spondylolysis occurs due to a crack, stress fracture, or separation of the pars interarticularis. The fracture may develop on one or both sides of the bone and most commonly occurs on the lower lumbar spine's fifth vertebrae. Spondylolysis commonly happens due to repetitive stress on the vertebra from intensive sports.
Spondylolysis may progress if left untreated, and result in spondylolisthesis or a slipped vertebra. However, spondylolisthesis develops from various sources, including improper spinal development, degeneration of discs, or a damaged spinal structure.
What Causes Spondylolisthesis?
Spondylolisthesis has a variety of causes. In children, it is often due to a congenital disability in that area of the spine. Also, adolescents may develop it during periods of rapid growth. Some people develop this condition because of an overuse injury called spondylolysis. Strain or stress on the lower back from intensive sports, such as football, weightlifting, or gymnastics, may contribute to the condition's development.
In adults, arthritis and the loss of disc elasticity that results from aging are the most common causes of spondylolisthesis. The lumbar spine is susceptible to injury because it carries and absorbs the person's weight. As the person contorts, stretches, rotates, and moves around, the vertebra's excessive stress may lead to gradual slippage.
Less commonly, spondylolisthesis can result from a sudden injury that leads to a broken vertebra. Diseases or tumors that weaken the spine can also result in spondylolisthesis.
Symptoms of Spondylolisthesis
Symptoms vary from person to person. Many people who have this condition have no symptoms at all. However, depending on the severity of your condition, some of the most common spondylolisthesis symptoms include:
Lower back pain
Hamstring spasms and thigh pain
Foot numbness or tingling
Stiffness in your back, legs, and buttock muscles
Bowel or bladder control issues
Protruding abdomen or swayback
Difficulty walking or standing for extended periods
Pain from bending over
How Is Spondylolisthesis Diagnosed?
A doctor will have visibility to inspect your lower spine to determine whether your vertebra is out of place and examine the possible slip. Be prepared to experience mild irritation as your doctor may need to touch your sensitive areas or ask you to do tasks that trigger your pain.
The physician will also check for possible bone fractures, which may involve diagnostic imaging to view the displaced bone, soft tissue, or discs. CT scans and other technology help your physician create an ideal treatment plan.
Once the doctor confirms a spondylolisthesis diagnosis, the condition will be graded from one to five:
Grade I is a less than 25% slip.
Grade II is a 25% to 49% slip.
Grade III is a 50% to 74% slip.
Grade IV is a 75% to 99% slip.
Grade V is the most severe and indicated the vertebra has fallen off the vertebra below it.
Treatment for Spondylolisthesis
Treatment options depend on the severity of your condition. You may benefit from rest. Medications may relieve your pain. A back brace may help, and you may benefit from physical therapy. If those methods are not successful, you may need a surgical procedure to reduce nerve compression or stabilize your spine. Ultimately, your physician will determine the approach to treatment by the severity and grade of the condition.
The best non-surgical approaches to treat spondylolisthesis include:
Physical therapy exercises to strengthen the lower back and abdomen
Anti-inflammatory drugs such as Advil to relieve pain. Prescription medication may be required for severe cases. If your doctor prescribes painkillers, please be careful as they are habit-forming.
Epidural steroid injections directly in the damaged area
A back brace to stabilize the spine and allow fractures to heal
Refrain from intense sports and physical activity
Patients with high-grade spondylolisthesis may require a spinal fusion. A surgeon will fuse the affected vertebrae to form one, solid bone to eliminate excessive motion between the vertebrae.
The physician will realign the vertebrae in the lumbar spine and use a bone graft between the vertebrae. The surgeon may insert metal rods to assistant the stabilization of the spine. Surgical success is extremely high but may limit spinal flexibility. The procedure can help stabilize the spine, restore mobility and function and relieve pain on the stressed nerve.Learn more about our treatment options by visiting the Spine Center at Resurgens Orthopaedics.