SPONDYLOLISTHESIS

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).ll.

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Common Types of Spondylolisthesis

Degenerative Spondylolisthesis.

The most common form of spondylolisthesis, degenerative 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. For more information watch the video to the right. right.

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 spinal affliction 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.

What Causes Spondylolisthesis

Spondylolysis describes a defect in the bony ring of a vertebra. It mainly affects the lowest lumbar vertebra. The bony ring, formed by the pedicle and lamina bones, protects the spinal cord and spinal nerves. The bone is weakest between the pedicle and lamina, an area called the pars interarticularis-“pars” for short. A pars defect is believed to be a stress fracture. A stress fracture happens from repeated strain on a bone. At first, the body is able to heal the damage. If the repeated strains happen faster than the body can respond, the bone eventually fractures. People are not born with spondylolysis. It commonly first appears in childhood. Football linemen and gymnasts are affected the most.

Spondylolisthesis Symptoms

The most common symptom of spondylolisthesis is spreading lower back pain. The pain is caused by the slipped vertebrae pressing on a nerve.  This spinal disorder 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 evaluated 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, to low back pain, numbness, and tingling in the legs and feet.

Diagnosis

To diagnose Spondylolisthesis, an examination and an X-ray of the lower back will be performed. It can identify any slipped vertebra, ones that are out of alignment. However, your doctor may order more tests if a more detailed image is needed. If so, a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan may be ordered.

Spondylolisthesis Treatment

Treatment options for spondylolisthesis range from rest, physical therapy, 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.

Physical Therapy

Your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.

Positions, movements, and spondylolisthesis exercises are prescribed to reduce pain. Hamstring flexibility is addressed, along with strength and coordination exercises for the low back and abdominal muscles. Sports participants benefit from an assessment of their technique and equipment. Therapy sessions may be scheduled two to three times each week for up to six weeks.

The goals of physical therapy are to help you:

  • learn to manage your condition and control symptoms
  • learn correct posture and body movements to reduce back strain
  • maximize your flexibility and core strength

Learn more about spinal rehabilitation.

Medication

Medications may be used for short periods to control pain, ease muscle spasms, and help regain a normal sleep pattern (if you are having trouble sleeping). Short periods of bed rest may help with acute painful episodes.

Learn more about medications used to treat back pain.

If conservative treatment is not enough to stabilize the spine and relieve the pain and swelling, surgery may be necessary.

Dr. Hostin speaks about degenerative Spondylolisthesis
Spondylolisthesis X-ray after surgery

Spondylolisthesis spine x-ray post-surgery

Surgery for Spondylolisthesis

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 movement 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 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 of 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.

“It was literally unbearable pain. It was hard to even get on the ground to play with my son. I definitely couldn’t pick him up. I couldn’t carry him around, and it made me feel like less of a mom. So I went to Dr. Hostin and we decided to go ahead with the surgery. I can play with my son now, and that makes me so happy.”

Testimonal from Carrie Grasso

If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis Institute at 214-556-0555 to make an appointment.