 Spondylolisthesis
Overview | Types of Spondylolisthesis | Symptoms | Diagnosis | Treatment | FAQ
Overview
Spondylolisthesis occurs when one of the bones (vertebra) in the spine moves forward and out of place. This happens most often in the lower back or lumbar region of the spine but can happen anywhere along the spine. Some people may experience no symptoms at all. Other people with spondylolisthesis may develop mild to severe back and leg pain.
Types of Spondylolisthesis
While there are various types of spondylolisthesis, there are two types of the condition that occur more often. The two common types are degenerative spondylolisthesis and spondylolytic spondylolisthesis. There are other less frequent occurring types of Spondylolisthesis. The condition may occur as result of a severe fracture or a spinal tumor, which may result in the vertebra slipping forward.
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Degenerative Spondylolisthesis
As people get older, the wear and tear from daily life can cause changes in the spine. The discs that provide padding between each bone, known as intervertebral discs, begin to lose water and become weaker. The intervertebral discs also become thinner, non-flexible and start to bulge. As the discs become less fluid they are unable to handle movement and motion from the body. As the disc degenerates, arthritis and degenerative spondylolisthesis may result.
Arthritis causes weakening in the joints and ligaments that hold the vertebrae in position. The ligament located at the back of the spine known as the ligamentum flavum can begin to collapse. This may allow the vertebrae on either side of a worn, flattened disc to loosen and slip forward on top of the vertebra below.
When the vertebra moves forward out of place this may result in narrowing of the spinal canal resulting in pressure on the spinal cord. Narrowing or shrinking of the spinal canal is called spinal stenosis and is common condition for patients with degenerative spondylolisthesis.
Spondylolytic Spondylolisthesis
When a bone in the lower back (lumbar spine) breaks and results in a vertebra slipping forward this is known as spondylolytic spondylolisthesis. A break such as this usually occurs in the pars interarticularis area of the lumbar spine. In many instances of spondylolytic spondylolisthesis, the pars fracture may occur during the teenage years and remains unnoticed until adulthood. Disc degeneration that occurs in adulthood as a result of everyday wear and tear can then add strain to the pars fracture and cause the vertebra to slip forward. This type of spondylolisthesis is commonly seen in middle-aged men. With spondylolytic spondylolisthesis only the front part of the vertebra slips out of place, not the entire spinal bone, and narrowing of the spinal canal is less likely to occur than other types of spondylolisthesis.
Spondylolysis and spondylolisthesis occurs in approximately 4-6% of the United States population. Many people live with the condition for years without experiencing pain or other symptoms. 
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Degenerative Spondylolisthesis
Symptoms of degenerative spondylolisthesis are similar to that of spinal stenosis. Common symptoms include leg or lower back pain and weakness in the leg especially with extended standing or walking. Numbness, tingling, and / or pain that is often affected by posture may also be experienced in the leg. Relief of the symptoms may be found by bending forward or sitting. The relief is due to the space in the spinal canal opening up. Standing or walking increases the pain.
Spondylolytic Spondylolisthesis
Many patients with spondylolytic spondylolisthesis do not experience symptoms and may be surprised with the diagnosis. In many cases, these patients visit a doctor due to low back pain brought on by activities. Back pain may be accompanied by leg pain.
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Diagnosis
Outlined below are some of the diagnostic tools that your physician may
use to gain insight into your condition and determine the best treatment
plan for your condition.
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Medical history: Conducting a detailed medical history
helps the doctor better understand the possible causes of your back
and neck pain which can help outline the most appropriate treatment.
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Physical exam: During the physical exam, your physician will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
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X-rays are usually the first step in diagnostic testing
methods. X-rays show bones and the space between bones. They are of
limited value, however, since they do not show muscles and ligaments.
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MRI (magnetic resonance imaging) uses a magnetic field
and radio waves to generate highly detailed pictures of the inside of
your body. Since X-rays only show bones, MRIs are needed to visualize
soft tissues likediscs in the spine. This type of imaging is very safe
and usually pain-free.
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CT scan/myelogram: A CT scan is similar to an MRI in
that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves. A local
anesthetic is injected into the low back to numb the area. A lumbar
puncture (spinal tap) is then performed. A dye is injected into the
spinal canal to reveal where problems lie.
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Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup. These
tests, called electromyography (EMG) or somato sensory evoked potentials
(SSEP), assist your doctor in understanding how your nerves or spinal
cord are affected by your condition.
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Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton. Bone
scans are also used for finding lesions for biopsy or excision.
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Discography is used to determine the internal structure
of a disc. It is performed by using a local anesthetic and injecting
a dye into the disc under X-ray guidance. An X-ray and CT scan are performed
to view the disc composition to determine if its structure is normal
or abnormal. In addition to the disc appearance, your doctor will note
any pain associated with this injection. The benefit of a discogram
is that it enables the physician to confirm the disc level that is causing
your pain. This ensures that surgery will be more successful and reduces
the risk of operating on the wrong disc.
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Injections: Pain-relieving injections can relieve back
pain and give the physician important information about your problem,
as well as provide a bridge therapy.
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Treatment Options
Non surgical spine care
Conservative treatments should always be considered first when treating
spondylolysis and spondylolisthesis. Non surgical treatment methods include resting and refraining
from usual activities, taking anti-inflammatory medication, and incorporating a stretching and strengthening program. Try our home remedy exercises. But remember, no exercise should be painful. Stop if they cause an increase in pain or symptoms. Injection therapy may be prescribed to help relieve pain and return the patient to activity and physical therapy which can strengthen the spine and help relieve pain.
Spine surgery
Surgery for degenerative spondylolisthesis should be considered after exhausting nonsurgical treatment, such as physical therapy or injection therapy, for at least 3 to 6 months.
The spine specialist will consider the amount of arthritis in the spine as well as whether the spine has excessive movement.
Patients with degenerative spondylolisthesis that require spine surgery are often unable to stand or walk and have reduced quality of life because of the pain and/or weakness.
Patients diagnosed with spondylolytic spondylolisthesis are often advised to exhaust non surgical spine treatment for at least 6 to 12 months before considering surgery.
Surgery may be necessary for cases where the vertebra slips forward further or the individual has severe neurological symptoms (i.e. weakness, numbness, or cauda equina syndrome.
About surgery for spondylolisthesis
The goal of spine surgery for both degenerative spondylolisthesis and spondylolytic spondylolisthesis is to relieve pressure from the nerves.
In order to relieve the pressure, the spinal canal is opened, this is called a laminectomy. A spinal fusion may follow in order to fuse together the vertebrae and form a single, solid bone. Click here to learn more about spinal fusion.
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FAQs
Who is at most risk for developing degenerative spondylolisthesis?
Degenerative spondylolisthesis occurs more often in women than men and people over the age of 50 are more likely to develop the condition. The African-American population has a higher incidence of degenerative spondylolisthesis as well.
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