About spondylolisthesis

What is spondylolisthesis?

Spondylolisthesis facts

  • Spondylolisthesis is a forward or backward slippage of one vertebra on an adjacent vertebra.
  • Causes of spondylolisthesis include trauma, degenerative, tumor, and birth defects.
  • Symptoms of spondylolisthesis include
    • lower back or leg pain,
    • hamstring tightness,
    • numbness and tingling in the legs.
  • The diagnosis of spondylolisthesis is based on imaging.
  • Most people with spondylolisthesis can be treated conservatively, without the need for surgery.
  • Patients who fail to improve with conservative treatment may be a candidate for surgery.

What is spondylolisthesis?

Spondylolisthesis (spon + dee + lo + lis + thee + sis) is a condition of the spine whereby one of the vertebra slips forward or backward compared to the next vertebra. Forward slippage of an upper vertebra on a lower vertebra is referred to as anterolisthesis, while backward slippage is referred to as retrolisthesis. 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). Spondylolisthesis is most common in the low back (lumbar spine) but can also occur in the mid to upper back (thoracic spine) and neck (cervical spine).

What are the symptoms for spondylolisthesis?

Leg tingling symptom was found in the spondylolisthesis condition

Sometimes, people with spondylolisthesis don’t notice anything is wrong. Symptoms include:

  • Lower back pain
  • Muscle tightness and stiffness
  • Pain in the buttocks
  • Pain spreading down the legs (due to pressure on nerve roots)
  • Pain that gets worse with activity
  • Tight hamstrings
  • Trouble standing or walking

What are the causes for spondylolisthesis?

There are six main types of spondylolisthesis. The type you have is determined by the cause. The types include:

  • Congenital spondylolisthesis. A vertebra is defective from the time a person is born.
  • Isthmicspondylolisthesis. This is caused by another condition called spondylolysis. In spondylolysis, a fracture, or crack, in the thin part of a vertebra can result in vertebrae slipping backward, forward, or over a bone below.
  • Degenerative spondylolisthesis. Over time, the disks that cushion vertebrae dry out and get thinner. This thinning makes it easier for a vertebra to slip out of place.
  • Traumatic spondylolisthesis. An injury or trauma causes a vertebra to slip out of place.
  • Pathological spondylolisthesis. Another condition such as osteoporosis or cancer causes it.
  • Post-surgical spondylolisthesis. A vertebra slips out of place after spinal surgery.

What are the treatments for spondylolisthesis?

The initial treatment for spondylolisthesis is conservative and based on the symptoms.

  • A short period of rest or avoiding activities such as lifting and bending and athletics may help reduce symptoms.
  • Physical therapy can help to increase range of motion of the lumbar spine and hamstrings as well as strengthen the core abdominal muscles.
  • Anti-inflammatory medications can help reduce pain by decreasing the inflammation of the muscles and nerves.
  • Patients with pain, numbness, and tingling in the legs may benefit from an epidural steroid (cortisone) injection.
  • Patients with isthmic spondylolisthesis may benefit from a hyperextension brace. This extends the lumbar spine, bringing the two portions of the bone at the defect closer together, and may allow for healing to occur.
  • Home remedies for spondylolisthesis are similar to those for low back pain and include ice, heat, and over-the-counter analgesics such as acetaminophen (Tylenol) and anti-inflammatory medications.

For those whose symptoms fail to improve with conservative treatment, surgery may be an option. The type of surgery is based on the type of spondylolisthesis. Patients with isthmic spondylolisthesis may benefit from a repair of the defective portion of the vertebra, or a pars repair. If an MRI scan or PET scan shows that the bone is active at the site of the defect, it is more likely to heal with a pars repair. This involves removing any scar tissue from the defect and placing some bone graft in the area followed by placement of screws across the defect.

If there are symptoms in the legs, the surgery may include a decompression to create more room for the exiting nerve roots. This is often combined with a fusion that may be performed either with or without screws to hold the bone together. In some cases, the vertebrae are moved back to the normal position prior to performing the fusion, and in others the vertebrae are fused where they are after the slip. There is some increased risk of injury to the nerve with moving the vertebra back to the normal position. Outcomes and recovery after surgery are improved with physical therapy rehabilitation.

What are the risk factors for spondylolisthesis?

There are six main types of spondylolisthesis. The type you have is determined by the cause. The types include:

  • Congenital spondylolisthesis. A vertebra is defective from the time a person is born.
  • Isthmicspondylolisthesis. This is caused by another condition called spondylolysis. In spondylolysis, a fracture, or crack, in the thin part of a vertebra can result in vertebrae slipping backward, forward, or over a bone below.
  • Degenerative spondylolisthesis. Over time, the disks that cushion vertebrae dry out and get thinner. This thinning makes it easier for a vertebra to slip out of place.
  • Traumatic spondylolisthesis. An injury or trauma causes a vertebra to slip out of place.
  • Pathological spondylolisthesis. Another condition such as osteoporosis or cancer causes it.
  • Post-surgical spondylolisthesis. A vertebra slips out of place after spinal surgery.

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