The term spondylolisthesis comes from the Greek words spondylos, meaning vertebrate, and oliothesis, meaning slipping. Spondylolisthesis describes the abnormal slipping or dislocation between two vertebrate. It’s a pure mechanical failure where a link in the central pillar is unstable.
Many people with spondylolisthesis have no symptoms while others may have chronic low back pain, leg pain, or neurogenic claudication from spinal stenosis.
What are the Symptoms?
- Many people with spondylolisthesis have no symptoms. However, symptoms may occur due to the weakness of the spine at the level of the spondylolisthesis. Abnormal movement or irritation at the level of the slippage may produce back pain.
- The pain is usually worse with activities such as standing and walking and is typically relieved with rest. This type of activity or posture related pain is referred to as mechanical pain.
- In other patients, symptoms may include leg pain (sciatica, radiculopathy) or even weakness and or numbness due to irritation of the nerve roots that can be stretched or compressed by the slipped vertebrate. In adult patients, the slippage may occur with other degenerative changes, so called arthritis or spondylosis of the spine, such as disc bulging, enlarging ligaments (hypertrophy), facet joint overgrowth and bone spurs. These changes may narrow the spinal canal, leading to spinal stenosis and neurogenic claudication.
Tests and Diagnosis :
- X-ray – X-rays provide an overall assessment of the bone anatomy as well as the curvature and alignment of the vertebral column.
- Dynamic, or flexion/extension X-rays (X-rays that show the spine in motion) may be obtained to see if there is any abnormal or excessive movement or instability in the spine at the affected levels.
- Magnetic resonance (MR) imaging – provides detailed images of soft tissues like the spinal cord and nerve roots. As a result, MRIs are very helpful in determining the location and severity of the stenosis and in identifying spinal cord or nerve root compression.
- Computed tomography scan (CT scan) – this scan uses X-rays and a computer to provide images that are more detailed than general X-rays.
- Non-operative treatment is usually recommended for patients as the first line of treatment. Physical therapy to work on posture, balance and spinal mechanics is often combined with strengthening of the back, flank and abdominal muscles to provide dynamic support to the lower lumbar spine.
- The careful use of over the counter anti-inflammatory medications along with periodic pain management for flare-ups, possible including spinal injections, can often make spondylolisthesis symptoms more manageable. Some weight loss, reconditioning, and life style modifications and ergonomic efficiencies may also be useful.
- Surgery is considered for patients who have severe, progressive and intolerable back and/or leg pain that does not improve with conservative treatments such as physical therapy, medication, and activity modulation. For patients with numbness and/or weakness surgery may also be considered.
- The objective of the surgery is to relieve the pressure that is on any of the nerve roots and to strengthen the attachment between the vertebrate.
- In adult patients with spondylolisthesis this usually consists of a decompression and spinal fusion (Minimally invasive surgery (MIS).