Spondylolisthesis occurs when a vertebra in the spine — most commonly in the lower back (lumbar spine) — slips forward. Most spondylolisthesis is asymptomatic, but it may cause pain and other symptoms that affect your mobility and quality of life.
Nonsurgical treatment for spondylolisthesis depends on the grade of slippage and whether or not the spinal nerves are compressed. Medications such as oral anti-inflammatory drugs, cortisone injections and physical therapy can help decrease pain, swelling and weakness.
Symptoms
Most people with spondylolisthesis have mild symptoms and the condition is often diagnosed only by an X-ray during an exam for something else. It can affect adults of any age but it is more common in people who participate in sports with repetitive motions or who work in labor-intensive jobs. Stress fractures and spinal arthritis can also weaken the vertebrae and cause them to shift forward.
Symptoms vary depending on how much the vertebra moves and whether it pinches a nerve as it exits the spine. Symptoms may include back or leg pain that gets worse when you bend over or twist. In some cases, spondylolisthesis is so severe that it causes numbness or weakness in one or both legs.
To diagnose spondylolisthesis, your doctor will ask about your symptoms and do a physical exam. They will probably order X-rays to see the extent of the vertebral slippage and any fractures in surrounding bones. They may also order a CT scan or an MRI to get more detailed images of the area.
Diagnosis
A physical exam is the first step in diagnosing spondylolisthesis. Your doctor will ask about your symptoms and your medical history, including any participation in sports or work activities that might have led to stress fractures of the spine or other damage over time. The doctor will then examine the back, observing your posture and gait. Children who participate in sports that require repeated spinal hyperextension are at greater risk for isthmic spondylolisthesis.
If your doctor suspects spondylolisthesis, they will request an X-ray of the back to look for signs of one vertebra shifting forward over the next. They may also order a CT scan or an MRI to get a better view of the back and determine how much the vertebrae have slipped.
Nonsurgical treatments for spondylolisthesis are often effective. They might include modifying or avoiding certain activities, weight loss, using pain medications or injections to reduce inflammation and swelling, and participating in physical therapy to help strengthen your back muscles. If your pain continues, surgery to fuse the spine together might be needed.
Treatment
A physical exam and X-rays can usually confirm that you have a slipped vertebra. Other tests, such as a CT scan or an MRI may be used to determine the extent of the slip and help plan treatment. Pain relievers and a back brace may ease symptoms. Your doctor may also prescribe special exercises to help strengthen your spine and prevent further problems.
Surgery is needed to treat severe spondylolisthesis or when symptoms are caused by spinal nerve compression (neuropathy). The type of surgery required depends on the degree of shift and whether it involves degenerative, traumatic or pathological spondylolisthesis.
For degenerative spondylolisthesis, your surgeon may recommend that you have spinal fusion surgery to take away pressure on the spinal nerves. In other cases, a procedure called spinal decompression surgery is needed to reduce the mechanical issues of instability in the spine. This is done by removing part of the facet joints or a portion of the spinal lamina, allowing the spine to move more easily.
Prevention
In degenerative spondylolisthesis, the facet joints and disc of the lower, or lumbar, spine develop wear and tear over time. This weakens the bones of the spine, which then slip forward onto the bone below. Most commonly, this occurs at the L4-L5 segment, but it can occur at other levels as well. In isthmic spondylolisthesis, there is a defect in an important bridge bone called the pars interarticularis. This type of spondylolisthesis often affects the lower, or lumbar, spine at the level of L5-S1.
Traumatic spondylolisthesis usually results from spinal fractures caused by sudden trauma such as vehicular accidents or falls. This kind of spondylolisthesis is more common in teenagers because the spine is still growing.
To prevent spondylolisthesis, you can reduce stress on your back by practicing proper posture and using good lifting techniques during heavy activities. You should also avoid repetitive, high impact activities that place a lot of stress on the spine, like running or playing sports. You should also avoid exercises that twist or bend your spine, like those used in weightlifting and gymnastics.
