Spondylolisthesis


Spondylolisthesis is a condition in which one vertebra slips in relation to another. It can be caused by a number of different mechanisms and affects all age groups, with different mechanisms being responsible for the slippage in each group. Spondylolisthesis is quite a common condition and can cause significant pain and limitation in people who are affected by this condition.

Lumbar spine anatomy lateral viewCauses of spondylolisthesis

Spondylolisthesis can be caused by any of the following mechanisms:

  • Congenital

Some people are born with a defect in specific areas of their spine (the facet). This allows one vertebra to slide forward. This type of spondylolisthesis often becomes evident in children and teenagers.

  • Isthmic

In this type, there is a defect in the pars articularis. This is a part of the vertebral arch. This type of spondylolisthesis can be caused by repetitive extreme movement, especially extension, for example in gymnasts.

  • Degenerative

More common in older people, this type of spondylolisthesis is caused by arthritic changes in the spine.

  • Trauma

Severe injury to the spine can cause spondylolisthesis, for example if part of the spine is fractured.

  • Pathological

Rarely, spondylolisthesis can be caused by a tumor in the spine.

 

Symptoms of spondylolisthesis

Spondylolisthesis occurs in different grades – from mild to severe. Depending on the severity of the condition, the following symptoms may be present:

  • Pain in the lower back, often worse after walking or exercise. Extending the back (straightening or leaning back) often also increases pain.
  • Stiffness in the lower back
  • Increased tightness of the hamstrings
  • If nerves are being compressed due to the condition, then you may have pain, numbness or tingling into your legs
  • In severe cases, control of bladder or bowel function may be affected.

Treatment for spondylolisthesis

 

Your physician will first carry out a thorough assessment to determine the severity of your condition. Spondylolisthesis will usually be evident on plain x-rays but further scans such as a MRI or CT scan may be ordered to see if there is pressure on other structures, such as nerves or the spinal cord.

In less severe cases, physical therapy may be of assistance. This treatment may consist of manual therapy, stretches to address the tightness of hamstrings and other structures and strengthening to ensure your core muscles are able to support your back. Your doctor may also prescribe medication to help manage your pain and reduce inflammation. Sometimes a back brace is used to stabilize the area.

For a number of people with more severe forms of this condition, surgery is recommended. This is especially the case if the slippage is severe or if there is pressure on the spinal cord or nerves. Surgery is aimed at providing more space for the spinal cord and nerve roots and stabilizing the spine. In some cases it can be effective at reducing pain. Your surgeon will discuss with you the most appropriate surgical technique for your condition.