In spondylolisthesis, the top vertebra slips forward in relation to the bottom vertebra. This may occur anywhere along the spine, but is most common in the lower lumbar spine or cervical spine. The forward move is called anterolisthesis and the backward movement is referred to as retrolisthesis. Anterolisthesis is more common and may be associated with stenosis or compression of the nerve roots with or without associated instability.
Segmental instability is defined as abnormal motion of the vertebral segment which is diagnosed on dynamic imaging with standing flexion and extension lateral x-rays.
Most common types of spondylolisthesis:
Degenerative spondylolisthesis is degeneration of the bilateral facets and the disc which results in forward slippage of the top vertebra over the bottom one. This is most often seen at lumbar 4 – 5 level.
Isthmic spondylolisthesis is most often at lumbar 5 – sacral one as a result of pars fracture also known as pars defect at lumbar five.
About 4% to 6% of the U.S. population has spondylolysis and spondylolisthesis. Most of these people live with the condition for many years without any pain or other symptoms.
Symptoms of Degenerative Spondylolisthesis
Patients with DS often visit the doctor’s office once the slippage has begun to put pressure on the spinal nerves. Although the doctor may find arthritis in the spine, the symptoms of DS are typically the same as symptoms of spinal stenosis. For example, DS patients often develop leg and/or lower back pain. The most common symptoms in the legs include a feeling of vague weakness associated with prolonged standing or walking.
Leg symptoms may be accompanied by numbness, tingling, and/or pain that is often affected by posture. Forward bending or sitting often relieves the symptoms because it opens up space in the spinal canal. Standing or walking often increases symptoms.
Symptoms of Spondylolytic Spondylolisthesis
Most patients with spondylolytic spondylolisthesis do not have pain and are often surprised to find they have the slippage when they see it in x-rays. They typically visit a doctor with low back pain related to activities. The back pain is sometimes accompanied by leg pain.
Surgery for both degenerative spondylolisis and spondylolytic spondylolisthesis includes removing the pressure from the nerves and spinal fusion.
Removing the pressure involves opening up the spinal canal. This procedure is called a laminectomy.
Spinal fusion is essentially a “welding” process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.
Although nonsurgical treatments will not repair the slippage, many patients report that these methods do help relieve symptoms.
- Physical therapy and exercise. Specific exercises can strengthen and stretch your lower back and abdominal muscles.
- Medication. Analgesics and non-steroidal anti-inflammatory medicines may relieve pain.
- Steroid injections. Cortisone is a powerful anti-inflammatory. Cortisone injections around the nerves or in the “epidural space” can decrease swelling, as well as pain. It is not recommended to receive these, however, more than three times per year. These injections are more likely to decrease pain and numbness, but not weakness of the legs.
In addition to exercise and weight management through a low-fat and low-sodium diet, maintaining proper posture is one way to mitigate – or even avoid – the symptoms associated with spondylosis and spondylolisthesis. It’s not always easy to remember to practice proper posture, of course.
One of the spine’s primary functions is to support the body’s weight, and it is crucial to maintain an even distribution across the series of vertebrae, muscles, ligaments, joints and intervertebral discs so that one or more segments never have to carry more of the load than they should.