Spondylolisthesis occurs when one spinal bone or vertebra slips out of place in relation to its neighboring vertebra. This condition can occur in both adolescents and adults. When this happens, the disc or ligaments between the bones may herniate or bulge, or the bones themselves may pinch your spinal nerves. Small slippage of your vertebrae can be managed conservatively with stabilization exercises and medications. Back and leg pain, however, can become more significant when the spondylolisthesis progresses.
Some patients with spondylolisthesis will have no symptoms while others may suffer from chronic low back pain, leg pain, or leg numbness/weakness. The compression of the spinal nerves causes stenosis, narrowing of the nerve channel, and leads to neurogenic claudication. When symptoms are severe or conservative management fails, fusion surgery is an excellent option to stabilize your vertebrae and definitively treat your spondylolisthesis. In addition to traditional surgical techniques, minimally invasive options may also be considered.
There are 5 main types of Spondylolisthesis that are caused from vertebrate slippage, which are:
- Isthmic: Commonly found in young adults where the slippage usually occurs in the lowest part of the spine. It is caused by a stress fracture in the back portion of the spine, which usually occur in young adults, but the symptoms may not occur until many years later.
- Degenerative: Usually found in adults, the vertebral slippage is caused by degenerative changes, wear and tear, in the disc and facet joints of the spine, which weakens the attachments between two adjacent vertebrae.
- Traumatic: This is when fractures arising from acute trauma to the spine may result in slippage of vertebrate.
- Dysplastic: Also known as congenital (present at birth) spondylolisthesis, which is caused by unusual development of the spine. It typically occurs in the lower lumbar and sacral spine.
- Pathologic: When an erosion or damage to the back portion of the spine that is caused from tumors, bone conditions, or even previous spinal surgery. This includes the lamina, facet joints and connecting ligaments which may also weaken the attachments between adjacent vertebrae and result in spondylolisthesis.
Common Symptoms of Spondylolisthesis
Although people with spondylolisthesis may have no complaints, symptoms can occur due to the weakness of the spine and nerve compression associated with the spondylolisthesis. Some common symptoms include:
- Back pain: caused by unusual movement or irritation at the level of slippage. It can worsen with activities such as standing and walking, but can typically be relieved with leaning forward or on objects such as a shopping cart.
- Leg Pain
- Weakness or numbness: caused from irritation of the nerve roots which can be stretched or compressed by the slipped vertebrae.
Slippage may occur along with other degenerative changes in adult patients. This is known as arthritis, or spondylosis of the spine, which causes disc bulging, enlarging ligaments (hypertrophy), facet joint overgrowth, and bone spurs.
Diagnosis of Spondylolisthesis
Spondylolisthesis, along with other spinal deformities, can be assessed with X-rays to see if there is any abnormal or excessive movement or instability in the spine at the affected areas. Dynamic or flexion/extension X-rays are used. Other imaging techniques commonly used in the assessment of a spondylolisthesis include:
- Magnetic Resonance Imaging (MRI)
- Computed Tomography Scan (CT Scan)
Treatment Options for Spondylolisthesis
There are two options to treat spondylolisthesis, which include:
- Physical Therapy: Works on posture, balance and spinal mechanics which is commonly combined with strengthening of the back, flank and abdominal muscles to provide support to the lower lumbar spine.
- Over the counter use of anti-inflammatory medications along with periodic pain management.
- Spinal injections, such as an epidural steroid injection, are reserved for pain that is unresponsive to rest, PT, and medications.
For patients who suffer from severe, progressive, and intolerable back and/or leg pain that doesn’t improve with nonoperative treatments, or if there is any numbness and weakness, surgery is often the appropriate treatment. The main goal of the surgery is to relieve the pressure on the nerve roots and to then strengthen the spine through a fusion.