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Spine Conditions

Diseases

SPONDYLOLISTHESIS

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:

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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.

SYMPTOMS

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.

TREATMENT

Surgical Treatment

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.

surgeon holding device

Nonsurgical Treatment
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.

PREVENTION

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.

Dr Hamid Mir M.D.

Meet

Dr. Hamid Mir, M.D.

Medical Director at DISC Sports and Spine Center in Newport Beach Dr. Hamid Mir is a board certified orthopedic spine surgeon with fellowship training in combined neurosurgical and orthopedic spine surgery. He has offices in Orange County and Los Angeles serving Costa Mesa, Newport Beach, Marina Del Rey, Santa Monica, Riverside, and Palm Springs. Specializing in cervical, thoracic, and lumbar diseases including degenerative, stenosis, fracture, infection, scoliosis, revision, and complex reconstructions.

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Testimonials

You are more than just a patient.

I was in a very bad situation herniating a disc in my lower back so I made an appointment with DISC and Dr. Hamid. The Doctor was very professional and made me comfortable that he understood exactly what I was going through and was able to communicate effectively exactly what it will take to get me on the road to recovery. It took several months as my injury was severe however I always felt I was in good hands under Dr. Hamid’s supervision…If you ever have the misfortune of injuring your circuit board of your body (spine) you need a pro, do not take advice from anyone who’s not specifically licensed to help, Dr Hamid is who I chose and I’m very thankful.
- Matteo B
- Matteo B
Dr. Mir saw me about 2 months before the procedure and indicated that I had severe stenosis or narrowing of the openings where the nerve roots exit at the L4, L5 and S1 level. He reviewed my MRI and without wasting any time, asked if I wanted or was considering surgery. He was extremely clear and answered all my questions. I had the procedure done at the Disc Newport OP surgery center and was cared for by an incredibly competent, caring staff. I was discharged same day and my post op recovery was 2 weeks, and returned to work July 15th. The procedure was very successful as my pain is basically gone. Amazing relief from a procedure done by a great doctor with a great staff!
- Stan W.
- Stan W.
Dr. Mir is an excellent spine surgeon. had a surgery on my neck by another surgeon but I was still in pain. A friend who had prior surgery with Dr. Mir recommended him to me. He is very detail oriented, confident, and knowledgeable. His staff is very friendly and helpful. I decided to have a second operation on my neck. Soooo thankful I have no pain.
- Hillary C.
- Hillary C.
Dr. Mir and his entire staff take the extra time and consideration to shape alternatives to meet the needs (holistically) of the patient. Everything about the experience of my surgery was positive. Dr. Mir is patient and compassionate. His communication skills are remarkably attentive. We are six months out of the starting gate from surgery, and with PT and core strengthening exercises, this 65 yr. old is back to regular training for next year’s marathon. Thank you kindly El Doc-tor….you are amazing! See you soon.
- Lorena B.
- Lorena B.

Dr. Hamid Mir is a member of American Board of Orthopedic Surgery with fellowship training in combined neurosurgical and orthopedic spine surgery at Cedars Sinai Medical Center in 2004. As a top rated spine surgeon, he specializes in cervical, thoracic, and lumbar spine diseases including degenerative, stenosis, fracture, infection, scoliosis, revision, and complex reconstructions.

Dr. Mir focused his practice on minimally invasive techniques. As Medical Director of DISC Sports & Spine Center, Dr. Mir is at the forefront of the field of minimally invasive spine surgery. The benefits of these techniques include less post-operative pain, quicker recovery reduced blood loss, less soft tissue damage, smaller surgical incisions, less scarring and improved function.

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