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).

scoli-quiz

Common Types of Spondylolisthesis

Degenerative Spondylolisthesis.

The most common form of spondylolisthesis, occurs because of spinal discs as 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 keep the vertebra in place) can become misaligned. As a result, one vertebra may begin to slip over another. So, degenerative spondylolisthesis usually occurs in adults over 40 and more frequently in women.  right.

Isthmic Spondylolisthesis.

This type of spondylolisthesis is related to another condition called spondylolysis, which involves fractures in the pars interarticularis (literally, “the space between two joints”), a small piece of bone that connects facet joints.  Also, this type of spinal affliction can affect all ages, but is usually seen in children and adolescents due to the fact that their bones continue to grow.

Congenital Spondylolisthesis.

Also called dysplastic spondylolisthesis, this condition results from abnormal bone formation before birth. For instance, congenital spondylolisthesis can lead to stress on the pars interarticularis, causing fractures.

Other, less common forms of spondylolisthesis include:

Traumatic 

Caused by trauma to the vertebrae resulting in a spinal fracture or slipping.

Pathological 

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 

As the name suggests, this type of spondylolisthesis occurs or worsens following spinal surgery.

Spondylolysis and Spondylolisthesis

Contrary to popular opinion and the way the two terms are used interchangeably, spondylolysis and spondylolisthesis are two different conditions. While spondylolysis refers to a condition in which there’s a defect in a portion of the spine, a small bony arch in the back portion becomes separated and affects the entire spine physically as well as its functions, spondylolisthesis refers to anterior slippage of the vertebra in front of the spine, one over another. 

Spondylolisthesis mainly occurs at the L5-S1 level although it may occur at the L4-L5 level but rarely higher than that.

Although spondylolysis could affect different parts of the spine including the lumbar vertebra causing lumbar spondylolysis, spondylolisthesis can occur from different things including spondylolysis (unilateral or bilateral pars interarticularis defect) which is the most common cause. This is mainly because a crack in the spine more easily predisposes the vertebrae to slip over one another. 

The other causes of spondylolisthesis include; congenital defects, degenerative disc disease, trauma or even pathological conditions.

What Causes Spondylolysis

Spondylolysis describes a defect in the bony ring of a vertebra. For example, it mainly affects the lowest lumbar vertebra. Meanwhile, 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 — “pars” for short.  Also, a stress fracture happens from repeated strain on a bone. At first, the body heals the damage. If the repeated strains happen faster than the body can respond, the bone will fracture.

Spondylolysis occurs in adolescents and young athletes since they get involved in sports that put the spine under pressure and the fracture occurs.

Besides sports, doctors rarely see other causes of spondylolysis; although, having a thin spine from birth may predispose an individual to more stress on the bones to cause a fracture.

Spondylolisthesis Symptoms

The most common symptom of spondylolisthesis is spreading lower back pain. As a result, the pain occurs because of a slipped vertebrae pressing on a nerve.  This spinal disorder often gets mistaken for a simple back strain, especially because muscle spasms indicate another common symptom. In fact, many people don’t realize they have a serious issue until they get 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 a strange gait. In addition, to low back pain, numbness, and tingling in the legs and feet.

Diagnosis

To diagnose Spondylolisthesis, doctors examine the patient and take an X-ray of the lower back. 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, the doctor can order a CT scan or a MRI scan.

Spondylolisthesis Treatment

Treatment options for spondylolisthesis range from rest, physical therapy, and medication to surgery that will depend largely on age, overall health, as well as the severity of the slippage.

The most common course of treatment is non surgical.

Physical Therapy

Your doctor may have you work with a physical therapist. Furthermore, a well-rounded rehab program assists in calming pain, 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. Also, patients should schedule therapy sessions — 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

Doctors will use medications 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 pain.

Learn more about medications used to treat back pain.

Doctors may recommend surgery If the usual treatments do not stabilize the spine and relieve the pain and swelling.

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 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 become 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 stay at the hospital for a few days. During this time, they will learn things such as movements to avoid, and 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 typically recover within 8-12 weeks with a non surgical 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.”

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.