Spondylolisthesis
Spondylolisthesis is a condition in which one of the bones in your spine (vertebrae) slips out of place and moves on top of the vertebra next to it. It usually happens at the base of your spine (lumbar spondylolisthesis). When the slipped vertebra puts pressure on a nerve, it can cause pain in your lower back or legs.
Spondylolysis and spondylolisthesis are different conditions of the spine, though they're sometimes related. Both conditions cause pain in your lower back. Spondylolysis is a weakness or small fracture (crack) in one of your vertebrae. This usually affects your lower back, but it can also happen in the middle of your back or your neck. It's most often found in kids and teens, especially those involved in sports that repeatedly overstretch the lower spine, like football or gymnastics.
It's not uncommon for people with spondylolysis to also have spondylolisthesis. That's because the weakness or fracture in your vertebra may cause it to move out of place.
There are six main types of Spondylolistheses:
Degenerative spondylolisthesis: This is the most common type. As people age, the disks that cushion vertebrae can become worn, dry out, and get thinner. This makes it easier for the vertebra to slip out of place.
Isthmic spondylolisthesis: This type is caused by spondylosis. A crack in the vertebra can lead it to slip backward, forward, or over a bone below. It may affect kids and teens who do gymnastics, do weightlifting, or play football because they repeatedly overextend their lower backs. But it also sometimes happens when you're born with vertebrae whose bone is thinner than usual.
Congenital spondylolisthesis: Also known as dysplastic spondylolisthesis, this happens when your vertebrae are aligned incorrectly due to a birth defect.
Traumatic spondylolisthesis: In this type, an injury (trauma) to the spine causes the vertebra to move out of place.
Pathological spondylolisthesis: This type is caused by another spine condition, such as osteoporosis or a spinal tumor.
Postsurgical spondylolisthesis: Also called iatrogenic spondylolisthesis, this happens when a vertebra slips out of place after spinal surgery.
Your doctor may give your spondylolisthesis a grade based on how serious it is. The most common grading system is called Meyerding's classification and includes:
- Grade I: The most common grade, this is defined as 1%-25% slippage of the vertebra
- Grade II: Up to 50% slippage of the vertebra
- Grade III: Up to 75% slippage
- Grade IV: 76%-100% slippage
- Grade V: More than 100% slippage, also known as spondyloptosis
Grades I and II are considered low grades. Grades III and up are considered high grades.
Causes
Causes of spondylolisthesis include:
- Injury to the spine
- Another condition such as osteoporosis
- Spinal surgery
- Wear and tear with age
- Birth defects
- Spondylolysis
You're more likely to get this condition if you:
- Take part in sports that put stress on your spine
- Were born with thinner areas of vertebrae that are prone to breaking and slipping
- Are 50 or older
Symptoms
Symptoms of Spondylolisthesis include:
- Tight hamstrings (muscles in the back of your thighs)
- Trouble standing or walking
- Lower back Pain
- Pain that gets worse with movement
- Muscle tightness and stiffness
- Pain in your buttocks
- Pain that spreads down the legs (due to pressure on nerve roots)
Symptoms
- Pain. For cervical radiculopathies, the pain often radiates from the neck and down the arm (sometimes to the shoulder/scapula). For lumbar and lumbosacral radiculopathies, the pain radiates from the low back down the buttock and leg.
Bladder or bowel changes. Less commonly, the nerves affecting the bladder and bowel can become compressed and contribute to loss of control and incontinence of bladder or bowel function
Diagnosis
Spondylolisthesis is diagnosed with history and physical and review of symptoms. Imaging tests such as x ray, CT scan and MRI scan will show if a vertebra is out of place and help establish a grade.
Treatment
Treatment depends on age, symptoms, and medical history as well as grade of spondylolisthesis. Low grade can usually be treated with physical therapy or medications. With high grade, surgery may be necessary.
Nonsurgical treatment options include:
- Rest: some time off from sports and other vigorous activities may be recommended.
- Medications: over-the-counter anti-inflammatory medicines to relieve pain, such as ibuprofen or naproxen.
- Injections: Steroid shots in the area where there is pain can bring relief.
- Physical therapy: Daily exercises that stretch and strengthen supportive abdominal and lower back muscles can lower pain.
- Braces: For children with fractures in the vertebrae (spondylolysis), a back brace can restrict movement so the fractures can heal.
Surgery
Surgery may be necessary with high-grade spondylolisthesis or serious pain and disability after nonsurgical treatments. This usually means spinal decompression, often along with spinal fusion.
Spinal decompression: Decompression lessens the pressure on the nerves in your spine to relieve pain. The surgeon may remove bone from your spine, take out part or all of a disk, and/or make the opening in your spinal canal larger.
Spinal fusion: In spinal fusion, the doctor joins, or fuses, the affected vertebrae together to prevent them from slipping again.
Pars repair: This surgery repairs fractures in the vertebrae using small wires or screws. Sometimes, bone graft is used to reinforce the fracture so it can heal better.
For most people, rest and nonsurgical treatments bring long-term relief within several weeks. But sometimes, spondylolisthesis comes back again after treatment. This happens more often with higher grades. Most people get back to normal activities within a few months.