Spondylolisthesis
Spondylolisthesis occurs when one vertebra slips forward on the adjacent vertebrae.
An Overview
Spondylolisthesis occurs when one vertebra slips forward on the adjacent vertebrae. The word comes from the Greek – spondylos, meaning “vertebra” and olisthesis, meaning “dislocation.” With this condition, one of the vertebrae in the spinal column moves out of place (forward, backward, or sideways) in relation to the vertebra below. This is one type of true spinal instability and can result in both back pain and neurologic problems.
Displacement of the vertebra can narrow the space in the spinal canal, as well as put pressure on adjacent nerves resulting in neurologic symptoms. Although spondylolisthesis can occur anywhere in the spine, the lower back (lumbar spine) is the most common area affected. To learn more about Dr. Akamnonu's spondylolisthesis surgery call today for your consultation.
Symptoms
Most individuals with spondylolisthesis experience pain when standing, walking, or bending backwards. Symptoms include:
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Severe or “burning” back pain
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Pain worse after exercise
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Sciatica, leg pain, weakness, and/or numbness
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Spondylolisthesis may also be associated with spinal stenosis and neurogenic claudication—cramping pain in the buttock and thighs associated with premature fatigue and tiredness when walking distances.
Isthmic Spondylolisthesis
This type of spondylolisthesis is caused by a fracture of the pars interarticularis or isthmus, the bony bridge that connects the facet joints. It is often associated with sports that involve repetitive stress to the lumbar vertebrae and/or entail hyperextension of the spine. If a defect in the pars interarticularis can be identified but no slippage has occurred, the condition is termed spondylolysis. If separation or displacement of this fracture occurs, the vertebra will disconnect from the facet joints that normally function to restrain the spine and maintain normal spinal alignment. The resulting slippage of the vertebrae is termed a spondylolisthesis.
Degenerative Spondylolisthesis
This type of spondylolisthesis is most often seen in older patients. In degenerative spondylolisthesis there is no pars defect and the vertebral slippage is never greater than 30%. This type is caused by arthritis of the paired facet joints in the back of the spine along with degeneration of the intervertebral disc. Arthritis of the joints can cause the joints to be painful and fit loosely. This may lead to instability of the spine with slippage of the vertebrae and further wear and tear on the intervertebral disc.
Congenital Spondylolisthesis
Present from birth and caused by abnormal bone formation in the spine. Spinal misalignment puts the vertebrae at greater risk for slipping out of place.
Pathological Spondylolisthesis
Brought on by disease (e.g., osteoporosis), infection, or abnormal growths (e.g., tumors) that cause bone weakness.
Post-Surgical Spondylolisthesis
Vertebrae can become displaced as a result of surgery.
Traumatic Spondylolisthesis
Direct injury to the spine can cause spinal fractures or displacement of vertebrae.
Types of Spondylolisthesis
Treatments
Early detection and diagnosis is important. Treatment is directed toward restoring spinal stability and preventing ongoing damage to the nerves.
The degree of vertebral slippage is obtained from spinal x-rays and graded as follows:
Grade I: 1-25%
Grade II: 26-50%
Grade III: 51-75%
Grade IV: 76%-99% slip.
Grade V: Complete slip (100%), known as spondyloptosis.
Some cases of spondylolisthesis can be treated with short-term bed rest, activity restriction, medication, and other non-operative options. If your condition does not
improve with conservative treatment, spondylolisthesis surgery can help to relieve pain and increase level of function. Spinal fusion is generally necessary to halt slip progression and stabilize the spine. When spinal stabilization is required, the most current minimally-invasive techniques may be employed, allowing shorter hospital stays, decreased pain, more rapid recovery, and a return to an active lifestyle.
Considerations when determining treatment include the degree of displacement and other factors such as intractable pain and neurological symptoms. Many cases of spondylolisthesis are Grade I or II. As a general rule, more severe slips (Grades III and higher) require surgical intervention.