Spondylolisthesis is a condition in which one of the bones of the spine (vertebrae) slips out of place onto the vertebra below it. If it slips too much, the bone might press on a nerve, causing pain. Spondylolisthesis usually affects the bones of the lower back (lumbar spine).
Degenerative spondylolisthesis. The most common form of spondylolisthesis, degenerative spondylolisthesis is the result of aging. As we get older, the discs between our vertebra (which usually act as shock absorbers) start to wear out, and the facet joints (which are supposed to keep the vertebra in place) can become misaligned. As a result, one vertebra may begin to slip over another.
Degenerative spondylolisthesis is most common in adults over 40 and occurs most frequently in women.
Isthmic spondylolisthesis. This type of spondylolisthesis is related to another condition, spondylolysis, which involves fractures in the pars interarticularis (literally, “the space between two joints”), a small piece of bone that connects facet joints. This type of spondylolisthesis can affect all ages, but it is more common in children and adolescents due to the fact that their bones are still developing.
Congenital spondylolisthesis. Also called dysplastic spondylolisthesis, congenital spondylolisthesis results from abnormal bone formation before birth. Congenital spondylolisthesis can lead to stress on the pars interarticularis, causing fractures.
Other, less common forms of spondylolisthesis include:
Traumatic spondylolisthesis. Caused by trauma to the vertebrae resulting in a spinal fracture or slipping.
Pathological spondylolisthesis. Pathological conditions such as infection, osteoporosis, or even cancer can cause the bones of the spine to become weak, leading to fractures and slippage.
Post-surgical spondylolisthesis. As the name suggests, this type of spondylolisthesis occurs or worsens following spinal surgery.
The most common symptom of spondylolisthesis is spreading lower back pain. Spondylolisthesis is often mistaken for a simple back strain, especially because muscle spasms are another common symptom. In fact, many people don’t realize they have a serious issue until they are seen by an orthopedist.
Other common symptoms include tightness, pain, and muscle spasms in the legs, thighs and buttocks, which can force the person to walk with an unnatural gait. In addition, the slipped vertebra can press on the nerve, causing pain, numbness and tingling in the legs and feet.
An X-ray of the lower back can show a vertebra out of place. However, your physician may need the more detailed images of computed tomography (CT) or magnetic resonance imaging (MRI) scans to more clearly see the bones and nerves involved.
Treatment options for spondylolisthesis range from rest and medication to surgical intervention, and depend largely on age, overall health, as well as the severity of the slippage.
The most common course of treatment is a conservative one that involves rest (and taking a break from any sports activities), medication to treat the symptoms, and specialized physical therapy exercises to strengthen the abdominal muscles and those around the spine. Typical medications include over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), but your doctor may prescribe something stronger if needed. Steroid injections may also be used to reduce inflammation.
If conservative treatment is not enough to stabilize the spine and relieve the pain and swelling, surgery may be necessary.
There are two surgical procedures used in the treatment of spondylolisthesis:
Decompressive laminectomy. This is a fairly common surgical procedure in which the portion of the bone or other tissue that is pressing on the nerves is carefully removed. While this surgery can relieve much of the pain, it leaves the spine somewhat unstable, so it’s sometimes done in conjunction with a spinal fusion.
Spinal fusion. In order to stabilize the spine and prevent motion which could damage it further, two or more of the vertebrae are fused together so that as they heal, they become one solid bone. This procedure can lead to some loss of spinal flexibility, but it more than makes up for it by preventing motion which may lead to further injury and pain.
Following a surgery, patients are typically kept for observation for a few days. During this time, you will learn things such as movements to avoid, and you may have to learn new ways to walk, sit and stand safely. After the hospital stay, your doctor may choose to put you in a brace to keep the spine properly aligned. Full recovery generally takes 3-6 months and depends largely on factors such as age, overall wellness, and the severity of your spondylolisthesis.
Most patients with minor to moderate spondylolisthesis are typically able to recover within 8-12 weeks with a conservative treatment approach. In addition, there are steps you can take to decrease your risk for developing spondylolisthesis. Maintaining a healthy weight is the best thing you can do, and exercises that strengthen the back and abdominal muscles can help a great deal. Try to choose activities that don’t put as much stress on the lower back, such as swimming, biking, and stretching/core-building exercises such as yoga, tai chi or Pilates.
If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis Institute at 214-556-0565 to make an appointment.