Spondylolisthesis

Introduction

Welcome to the Explaining Spondylolisthesis section, which is designed to help you learn more about spondylolisthesis and how it is treated.

What Is Spondylolisthesis?

I. Definition

The word spondylolisthesis derives from two parts - spondylo which means spine, and listhesis which means slippage. So, a spondylolisthesis is a forward slip of one vertebra (i.e., one of the 33 bones of the spinal column) relative to another. Spondylolisthesis usually occurs towards the base of your spine in the lumbar area.

II. Spondylolisthesis Description

Spondylolisthesis can be described according to its degree of severity. One commonly used description grades spondylolisthesis, with grade 1 being least advanced, and grade 5 being most advanced. The spondylolisthesis is graded by measuring how much of a vertebral body has slipped forward over the body beneath it.

How Do People Get Spondylolisthesis?

Approximately 5-6% of males, and 2-3% of females have a spondylolisthesis. It becomes apparent more often in people who are involved with very physical activities such as weightlifting, gymnastics, or football. Males are more likely than females to develop symptoms from the disorder, primarily due to their engaging in more physical activities. Although some children under the age of five may be pre-disposed towards having a spondylolisthesis, or may indeed already have an undetected spondylolisthesis, it is rare that such young children are diagnosed with spondylolisthesis. Spondylolisthesis becomes more common among 7-10 year olds and then again in people around 40 years of age. The increased physical activities of adolescence and adulthood, along with the wear- and-tear of daily life, result in spondylolisthesis being most common among adolescents and adults.

I. Types of Spondylolisthesis.
There are 2 main types of spondylolisthesis:
Degenerative Spondylolisthesis:

This type occurs in older patients and is caused by wear and tear of the disc and facet joints. There is no break in the ‘lamina’ ( part of  the vertebra at the back). The spinal canal narrows down, squeezing the nerves  and the symptoms are those of spinal stenosis:

• Increased leg pain or weakness on walking
• Eased on leaning forward or sitting down
• Easy to walk leaning forward on a shopping trolley, or cycling – but cannot walk straight.

The treatment options here include physiotherapy( not very effective, but worth a try)  , local injections like an epidural ( will give temporary pain relief) and  surgery to take the pressure off the nerves and stabilise the spine( posterior decompression/laminectomy and stabilisation).
If the stenosis is severe, patients usually end up needing surgery.

Lytic  Spondylolisthesis

Here there is a break in the lamina ( part of the vertebra at the back) and one vertebra slip forwards on the other. The spinal canal in usually not narrowed down- but the nerves can be squeezed causing leg  pain and difficulty walking.
Lytic spondylolisthesis can be caused in one of two ways: i. With all of the daily stresses that are put on a spine, such as carrying heavy items and physical sports, the spine may wear out (i.e., degenerate). As the connections between the vertebrae weaken, this may lead to a spondylolisthesis. ii. A single or repeated force being applied to the spine can cause a spondylolisthesis; for example, the impact of falling off a ladder and landing on your feet, or the regular impact to the spine endured by offensive linemen playing football.

II. What Symptoms Might I Notice?

Many people with a spondylolisthesis will have no symptoms, and will only become aware of the problem when it is revealed on an x-ray for a different problem. However, there are several symptoms that often accompany spondylolisthesis:

• Pain in the low back, especially after exercise
• Increased lordosis (i.e., swayback).
• Pain and/or weakness in one or both thighs or legs
• Reduced ability to control bowel and bladder functions
• Tight hamstring musculature
• In cases of advanced spondylolisthesis changes may occur in the way people stand and walk; for example, development of a waddling style of walking. This causes the abdomen to protrude further, due to the lowback curving forward more. The torso (chest, etc.) may seem shorter; and muscle spasms in the lowback may occur.

Surgery

Surgery may be recommended for your condition if nonoperative measures (e.g., rest, therapy, bracing), have not improved your condition.

Surgeons may try conservative approaches in some cases, such as bracing or a spinal exercise program, before proceeding to surgery. In the most advanced cases surgeons will probably recommend surgery as the first course of treatment.

This decision to do surgery is based on your symptoms, x-rays, and failure of conservative treatment. It is important that you understand why your physician is recommending a treatment. It is quite common for a spinal patient to seek another opinion regarding treatment. If this will make you feel more comfortable with your treatment program, do not hesitate to ask your physician for the name of another physician who handles similar spinal problems.

The goals of surgery are to remove pressure on spinal nerves (i.e., decompression), and to provide stability to the lumbar spine. In most cases of spondylolisthesis, lumbar decompression would need to be accompanied by uniting one spinal vertebra to the next (i.e. spinal fusion) with spinal instrumentation (i.e., implants that are often used to help aid the healing process). Surgery can be performed from the back of your spine (i.e., posterior) or from the front of the spine (i.e., anterior). Your spinal surgeon will review your particular problem with you and explain what type of surgery you need.

What are the results of Spinal Fusion and Decompression Surgery ?:

In general the results of surgery are very good. Your surgeon will advise on the particular circumstances of your case.