What exactly is Spondylolisthesis?
When one vertebra slips forward onto the vertebrae below it, this is called spondylolisthesis. This causes a gradual deformation of the lower spine as well as a narrowing of the vertebral canal. It is frequently associated with pain.
Spondylolisthesis is classified into five major types:
- Dysplastic- Dysplastic spondylolisthesis is caused by a congenital (present from birth) defect in the formation of a vertebral segment called the facet. This flaw has the potential to cause the vertebra to slip forward
- Isthmic- Isthmic spondylolisthesis is caused by a defect in the pars interarticularis of the vertebra. This flaw has the potential to cause the vertebra to slip forward.
- Degenerative- Degenerative spondylolisthesis occurs when the joints lose their ability to keep the spine aligned in its normal position due to arthritis. As a result, the vertebra may slip forward.
- Traumatic- Traumatic spondylolisthesis is caused by injury or trauma to the vertebrae. A pedicle, lamina, or facet fracture can cause the vertebra to slip forward.
- Pathologic- Pathologic spondylolisthesis is caused by structural bone weakness, which is usually caused by a disease, such as a tumor or another bone disease. Because of this weakness, the vertebra may slip forward.
What Are Spondylolisthesis Symptoms?
Some injuries or trauma, such as falling down the stairs or slipping, can sometimes lead to pain that persists for several months—chronic pain. When conservative therapies like medication and physical therapy don’t help to relieve the pain, there are other treatment options to consider, such as back surgery and chronic pain therapies. Talk to your doctor if your pain doesn’t seem to go away.
The degree of vertebral slippage has no direct relationship to the amount of pain a person will feel. Some people with spondylolisthesis will link the onset of their symptoms to an injury.
A person with spondylolisthesis may experience leg pain in addition to back pain. In this case, there may be associated narrowing of the area where the nerves exit the spinal canal, causing irritation of a nerve root.
How is it identified?
Many people who have spondylolisthesis have vague symptoms and little visible deformity. The tightness of the hamstring muscles in the legs is frequently the first physical sign of spondylolisthesis.
Plain lumbar spine x-rays are initially best for diagnosing spondylolysis or spondylolisthesis. Spondylolisthesis is most visible on lateral and oblique spine views, but in some cases, specialised imaging studies such as a bone scan or CT scan (CAT scan) are required to make the diagnosis. Dyplastic pars patients have an elongated interarticular region as well as altered pedicles. A CT scan is usually the best way to see this.
The amount that one vertebral body has slipped forward on another is used to grade spondylolisthesis:
- Grade I – Less than 25% slippage
- Grade II – Between 25% and 50% slip
- Grade III – Between 50% and 75% slip
- Grade IV – More than 75% percent slip
- Grade V – The upper vertebral body has slid completely forward off the front of the lower vertebral body. This is a very rare condition known as spondyloptosis
The discovery of a pars defect on a lateral x-ray or CT scan confirms the diagnosis of spondylolysis, and the forward position of one vertebral body on another confirms the diagnosis of spondylolisthesis
Views of the lumbar spine in flexion and extension may aid in determining the presence of spine instability (abnormal excessive motion between vertebrae upon movement). This movement could be a significant contributor to the pain you’re feeling and vital to the treatment plan you’re working on.
How is it handled?
Rest, followed by trunk and abdominal strengthening exercises, is the most common non-surgical treatment for spondylolysis and spondylolisthesis. A physical therapist can often help you get back on your feet and teach you how to do these exercises correctly without exacerbating your symptoms. If your leg pain is severe, you can also take an anti-inflammatory medication. Braces are rarely required, but they may be beneficial in reducing your symptoms. Injections of anti-inflammatory cortisol may also be beneficial.
Surgery to repair the defect in the pars interarticularis is only required for people with spondylolysis after non-surgical measures such as physical therapy and exercises have failed to relieve symptoms. Surgery may be used to directly repair the pars defect in younger people without a slip; in older people or those with some degree of instability, a spinal fusion may be required. If there is slippage, the two main goals are to unpin the nerves and to stabilize the spine internally. It is also possible to return things to normal alignment.