Spondylolisthesis

Overview

Spondylolisthesis is a condition in which a vertebra in the spinal column slips backward or forward and out of its original place. If a vertebra slips too much, it can press on a spinal nerve and cause pain. The term spondylolisthesis derives from two words: spondylo, which means spine, and listhesis, which means slippage.

Anatomy of the Spine

The spinal column supports your body and allows you to complete everyday movements like standing, bending down and twisting. The spine is made of 33 individual bones, known as vertebra. The vertebral column has a natural S-shaped curve, with each curve working to absorb shock, maintain balance and support your range of motion.

The vertebrae interlock with each other, but are split up into different sections, each of which has unique functions.

The cervical spine includes vertebrae C1 to C7, supports the weight of the head and allows neck movement.

The thoracic spine, or mid-back, holds the rib cage and protects the heart and lungs. The thoracic vertebrae are numbered T1 to T12.

The lumbar spine, or low back, includes the L1 to L5 and these vertebrae support the weight of the body.

Spondylolisthesis may occur anywhere within the spinal column, though, it is more prevalent in the lumbar spine.

spondylolisthesis diagram

What is Spondylolisthesis?

Spondylolisthesis is a spinal condition that results when one of the vertebrae slips forward or backward when compared to the vertebra adjacent to it.

The condition is most commonly diagnosed in adults and caused by degeneration of the discs and ligaments that bind and support the spine. Spondylolisthesis often begins in the teenage years, and with age, the intervertebral discs lose water content and ultimately height. As the vertebrae on either side of the disc come closer to each other, the upper vertebra slides forward over the sub-adjacent vertebra.

Spondylolisthesis can also be associated with deterioration of the facet joints that connect vertebrae. As the facet joints become arthritic due to deterioration, they enlarge in an attempt to maintain the stability of the spine.

As the two vertebral segments adjoining the spinal canal slide past each other, the spinal canal narrows in size. The combination of spinal canal narrowing and enlargement of the facet joints produces nerve compression problems found in degenerative spondylolisthesis.

Causes of Spondylolisthesis

Men are more likely to develop spondylolisthesis than women. Some children under the age of five may also be pre-disposed to the condition. However, it is more common among children in the 7 to 10 years old range. Depending on the type of spondylolisthesis, there are a number of different possible causes:

Congenital condition

Repetitive trauma

Arthritic changes in the facet joints

Direct trauma or injury to the vertebra

Structural weakness of the bone

Tumors or bone disease

Other risk factors that may lead to the development of spondylolisthesis include:

Family history of back problems

Previous back surgery

Infections

Chronic hypertension

Age

Playing high-impact sports

Types of Spondylolisthesis

There are several different types of spondylolisthesis with the most common being congenital spondylolisthesis, isthmic spondylolisthesis, and degenerative spondylolisthesis.

Congenital Spondylolisthesis

Congenital spondylolisthesis, also called dysplastic spondylolisthesis, indicates the condition is present at birth.

Spondylolisthesis can lead to a deformity of the spine as well as a narrowing of the spinal canal (central spinal stenosis) or compression of the exiting nerve roots (foraminal stenosis). Persistent pain associated with spondylolisthesis can lead to reduced mobility and inactivity. There is also a risk of permanent nerve damage if a slipped vertebra is pressing on a spinal nerve root.

Isthmic Spondylolisthesis

Specifically, isthmic spondylolisthesis occurs in a portion of the vertebra called the pars interarticularis. Isthmic spondylolisthesis can be caused by repetitive trauma and is more common in athletes exposed to hyperextension motions including gymnasts and football linemen. Isthmic spondylolisthesis can be the result of spondylolysis, a condition that leads to small stress fractures in the vertebrae.

Degenerative Spondylolisthesis

More common in older patients, degenerative spondylolisthesis occurs due to arthritic changes in the joints of the vertebrae due to cartilage degeneration. As you age, the spinal discs, which provide cushioning between the vertebrae, may lose water and be less able to resist movement by the vertebrae.

Less common forms of this condition include traumatic, pathological spondylolisthesis and post-surgical.

Symptoms of Spondylolisthesis

Spondylolisthesis can cause compressive or neurogenic symptoms. The forward slip of a vertebra also makes the spinal canal smaller, leaving less room for the nerve roots running between the vertebrae.

Compressive symptoms can also arise because the nerve roots at the segment involved are pinched with the narrow spinal canal. If there are compressive symptoms due to lumbar spondylolisthesis, there may be pain down the leg to the foot, numbness in the foot, and possibly weakness when trying to raise the foot.

The combination of spinal canal narrowing and enlargement of the facet joints produces the characteristics of nerve compression problems found in degenerative spondylolisthesis.

Lower back pain

Buttock pain

Pain that runs down the back of the leg

Weakness in the legs

Tingling or numbness

Pain that gets worse with a twist or bending over

Muscle strain-like discomfort

Muscle spasms in hamstring muscles

Difficulty walking or standing

Diagnosing Spondylolisthesis

Examination and Diagnostic Studies

Most of the symptoms from spondylolisthesis are aggravated by standing, walking and other activities. The first step in diagnosing the condition is a physical examination. You may have difficulty lifting your leg or completing simple exercises.

Imaging studies such as an MRI and CT scan are used to confirm the condition and demonstrate the degree of slippage in spondylolisthesis. The doctor may also use x-rays to look for any possible bone fractures, which could be the cause of nerve impingement or spondylolisthesis.

Grading Spondylolisthesis

After a physical exam and imaging studies are completed, a radiologist will determine to what degree slippage occurred. Spondylolisthesis may fall into four grades.

Grade I – Vertebral slip of up to 25%

Grade II – Slip between 26% and 50%

Grade III – 51% to 75% slip

Grade IV – 76% to 100% vertebral slip

Treatment for Spondylolisthesis

Treatment for spondylolisthesis will primarily depend on what type of spondylolisthesis it is and what symptoms the patient is displaying. Surgery may be necessary for spondylolisthesis treatment if medication, physical therapy, and exercise fail to keep the spondylolisthesis pain at a tolerable level.

Non-Surgical Treatment

Conservative treatment is common for Grade I and II spondylolisthesis. Treatment options may include:

Decreased activity until pain subsides

Over-the-counter anti-inflammatory drugs (NSAIDs), such as ibuprofen

Epidural steroid injections

Back support or brace

Physical therapy for improving flexibility and muscle strength

Surgical Treatment

Surgical treatment for spondylolisthesis must address nerve compression symptoms if they are present. This usually means that the nerves that exit the spine must be freed of all pressure and irritation.

The Bonati Spine Procedures offer an array of surgical techniques to treat spondylolisthesis, which may include:

A laminotomy/laminectomy , which is a decompression surgery for spinal stenosis and involves making an opening in the lamina to relieve pressure on the affected area and allow the nerve roots room to heal. This procedure is often utilized in order to give the surgeon the proper space to perform a foraminotomy/foraminectomy.

A foraminectomy/foraminotomy, which is a decompression surgery, performed in order to increases the space of the foramen and hollow out the passageway where the nerve roots exit the spinal canal. The procedure involves the removal of bone or tissue that obstructs the neuroforamen and compresses the nerve roots leading to inflammation and radiating pain. During this procedure the surgeons utilize specialized instrumentations to decompress the nerve roots as they exit through the foramen.

A discectomy, which involves the removal of a portion of the intervertebral disc that is putting pressure on the spinal cord or radiating nerves. A discectomy may be performed as part of the treatment for spondylolisthesis if the disc at the affected level is herniated.

Prevention & Self-Care

As spondylolisthesis may be the result of congenital and genetics, it is not fully preventable. Still, there are many steps you can take to reduce the risk of a vertebral slip.

Maintain the strength in your back and abdominal muscles

Maintain a healthy weight

Eat a well-balanced diet

Protect your back during sports or rigorous activities

Correct your posture

Stop smoking and avoid excessive consumption of alcohol

Learn to lift correctly

By following these tips, you can enjoy the benefits of a healthy spine at any age.

Outlook

Persistent pain as a result of spondylolisthesis can reduce mobility and lead to inactivity that can result in weight gain, loss of bone density, muscle atrophy and loss of flexibility.

The outlook for someone with spondylolisthesis depends on the grade of the slip. In the case of a minor slip, the individual may not suffer from a recurrence of back pain related to the condition because the nerves are not being impinged.

If the slip causes nerve compression, surgery may be required to decompress the nerves that are causing the pain.

The Bonati Spine Institute encourages patients with spondylolisthesis to contact us to request a no-obligation MRI review or discuss your conditions with our medical professionals. Find out why The Bonati Spine Procedures are considered to be among the world’s best solutions when it comes to advanced spine surgery. Your pain from spondylolisthesis can become a thing of the past.