Spondylolisthesis is a condition in which one of the vertebrae in the spine moves out of place and slips onto the vertebra below it. Any factors disrupting the vertebral alignment can lead to spondylolisthesis. The different types of spondylolisthesis include: congenital spondylolisthesis, degenerative spondylolisthesis and isthmic spondylolisthesis. The most common forms are the degenerative spondylolisthesis and spondylolytic spondylolisthesis. Spondylolisthesis is graded considering the amount of slippage of the vertebra.
Causes and risk factors of Spondylolisthesis
The causes of Spondylolisthesis vary with age, lifestyle and different forms of spondylolisthesis. These include:
- Degenerative Spondylolisthesis which occurs due to age-related wear and tear of the spinal elements causing degeneration of spinal discs and facet joints.
- Isthmic Spondylolisthesis which occurs due to weakened and fractured bones connecting the facet joints.
- Congenital Spondylolisthesis occurs due to abnormalities and misalignment of the spine before birth.
- Pathologic Spondylolisthesis occurs due to infections or disorders of the bones and connective tissues. (osteoporosis, tumours etc.)
- Traumatic Spondylolisthesis occurs as a result of trauma and fractures of the joint structures in the spine.
- Postsurgical Spondylolisthesis occurs as a result of spinal surgery.
Other risk factors of Spondylolisthesis include:
- Age
- Genetics
- Young Athletes (gymnastics, weight lifting, football)
Signs and symptoms of Spondylolisthesis
Most people who have spondylolisthesis may not experience symptoms, however some of the common symptoms among those experiencing them are:
- Lower back pain and tenderness
- Stiffness of the back.
- Weakness, stiffness and pain in the legs
- Numbness and tingling sensation
- Hamstring muscle spasms (back of the thighs)
- Increased pain while walking and standing for prolonged periods.
Diagnosis of Spondylolisthesis
Spondylolisthesis is diagnosed based on the patient’s medical history, physical examination and diagnostic imaging scans.
Physical examination: The doctor evaluates pain and tenderness with palpation after understanding your medical history. Physical examination may include assessment of different kinds of movements of the back such as bending backwards, forwards and sideways to identify the trigger points, degree of motion and location of pain.
Diagnostic imaging: X-rays are taken to assess the age-related changes, disc height and slippage of lumbar discs. They are taken while bending forward and backward to evaluate stability. CT-scans can provide cross sectional images with more specificity. MRI scan provides detailed image of the slipped disc, muscles, nerves and other soft tissues along with identification of nerve impingement.
Treatment of Spondylolisthesis
The treatment of spondylolisthesis involves non-surgical and surgical management.
Non-surgical methods
Although conservative management cannot reverse the slipped disc back to its position, it can help to provide symptomatic relief. These methods include:
Physical therapy: Physical therapy may include bed rest, use of a back brace for support and specific guided exercises for strengthening the back muscles.
Medications: Non-Steroid Anti-Inflammatory Drugs (NSAIDs) are given for pain relief and neurological medications are considered in cases of nerve impingement.
Epidural steroid injections: Steroid injections in the epidural space close to the surrounding nerves helps to relieve pain.
Surgical management
Surgical treatment of spondylolisthesis is considered for patients who do not respond to conservative treatments. Surgical intervention involves a combination of techniques including decompression, fusion and lumbar interbody fusion.
Decompression is done to relieve pain and pressure caused by nerve impingement. Spinal fusion involves placement of bone graft between two vertebrae to allow them to heal into a single bone. Addition of interbody fusion may be suitable for high grade spondylolisthesis. There has been an increased usage of minimally invasive techniques for decompression and fusion surgeries.
