Spondylolisthesis is a condition of the spine which arises when one of the vertebra slides backward or forward relative to the next vertebra. In most cases, it occurs in the lumbosacral or the lower areas of the spine. On some occasions, the condition may lead to the nerve roots in the spinal canal being squeezed, resulting in numbness and pain or weakness in either or both of the legs.
Types of Spondylolisthesis
There are five different types of Spondylolisthesis and they include the following:
- Dysplastic Spondylolisthesis – this is a congenital condition caused by the forward slippage of a part of the vertebra.
- Degenerative Spondylolisthesis – Degenerative spondylolisthesis happens as a result of arthritic changes happening in the joints of the vertebra due to the degeneration of cartilage as a result of old age. It is a condition more common in older patients.
- Isthmic Spondylolisthesis – Isthmic spondylolisthesis happens where there are defects in the parts of the vertebra known as pars interarticularis. If the defect is formed without any slippage, then the condition is referred to as spondylolysis. Treatment for this particular form of spondylolisthesis is common among athletes who are exposed to hyperextension movements, including football linemen and gymnasts.
- Pathologic Spondylolisthesis – Pathologic spondylolisthesis occurs due to defects in the bone caused by various bone abnormalities such as bone tumors.
- Traumatic Spondylolisthesis – Just as the name suggests, traumatic spondylolisthesis is caused by direct injury or trauma to the vertebra.
Lower back pain is the most common symptom of spondylolisthesis. The symptom often worsens following exercises involving extension of the lumbar spine. The other spondylolisthesis symptoms include:
- Buttock pains
- Tightness of the hamstrings
- Weakness or numbness in one or both legs
- Difficulty in walking
- Decreased range of motion and stiffness in the lower back
- Increased pains in the lower back, buttocks and legs when bending, standing or walking
- Loss of bowel or bladder control – this symptom happens in very rare occasions.
There are non-surgical and surgical treatments for spondylolisthesis, the choice of which will depend on the particular symptoms as well as the severity of the condition. In most cases, non-surgical treatments will be recommended and if this fails to bring relief to the patient, then minimally invasive surgical care will be considered.
Non-surgical spondylolisthesis treatments
Some of the non-surgical treatments for spondylolisthesis include:
- Physical therapy to increase the range of motion in the hamstrings and the lower back
- Short periods of rest to avoid activities such as lifting, bending, or contact with athletics and sports.
- Taking anti-inflammatory painkillers such as ibuprofen to reduce the pain and inflammation and,
- If there is considerable numbness, pain and tingling in the legs, corticosteroid injections may be recommended around the compressed nerve in the region of the neural foraminal of the spine (transforaminal epidural steroid injection).
The above treatments for spondylolisthesis may provide adequate pain relief and the the symptoms may disappear with time.
Surgical Spondylolisthesis Treatments
Surgical spondylolisthesis treatments are recommended only if the non-surgical options prove to be ineffective. The exact procedure will, however, depend on the type of spondylolisthesis diagnosed. With the surgical procedures, the slipped vertebra may be reduced and the spinal segment may be fused and fixated to prevent further slippage.
In some cases, the slipped disc of the vertebra may be removed and replaced with a Polyether etherketone Spacer (PEEK) with bone graft to separate between the vertebra. The goal of the surgery is to improve and prevent progression of the symptoms, free the pinched nerve roots by improving the foraminal stenois and prevent further movement and slippage of the vertebrae.
As part of the treatment plan, there are certain kinds of exercises which may be used to bring relief to the patients with spondylolisthesis. The essence of such exercises is to develop stronger back muscles and abdominal muscles to support the spine. As is the case with different spondylolisthesis treatments, spondylolisthesis exercises will also vary depending on the type and severity of the condition.
Some of the exercises recommended for spondylolisthesis include pelvic tilts, gluteal stretch, partial curl, quadruped arm and leg raises, side planks and double knee to chest exercises. The appropriate spondylolisthesis exercises should be recommended by a physician and they should stop immediately if the patient continues to experience more pain.
Dr. Shah Siddiqi will review different minimally invasive options with the patient. Texas Spine Center offers a FREE MRI scan review.