Spondylolisthesis

What is Spondylolisthesis?

Spondylolisthesis refers to a condition where one of the bones in your spine (a vertebra) slips out of place onto the bone beneath it. This slippage can result in mechanical issues or nerve-related symptoms and pain. The cause can be a birth defect, acquired due to injury or reasons that are unknown. The severity of spondylolisthesis is assessed based on how much the vertebra has slipped out of place in comparison to the bone beneath it.

What Causes Spondylolisthesis?

Spondylolisthesis is both a mouthful and a complicated condition. It comes in five main types: degenerative, isthmic, traumatic, dysplastic, or pathologic. Here’s how each type breaks down:

– Degenerative spondylolisthesis is a result of wear and tear changes in the spine. In this case, there’s no defect in a part of the spine called the pars interarticularis. Over time, the joints and discs in your spine break down, causing instability. That leads one backbone or vertebra to move forward in relation to the one next to it.

– Isthmic spondylolisthesis comes from issues in the pars interarticularis part of the spine. We don’t know exactly what causes it, but it might be connected to injury or strain in the teenage years from sports like wrestling, football, and gymnastics, which require repeated back extensions.

– Traumatic spondylolisthesis occurs because of fractures in the pars interarticularis or facet joint structure of the spine. It mostly happens as a result of trauma or injury.

– Dysplastic spondylolisthesis is present from birth and has to do with different alignment in the facet joints of the spine. In this type, the facet joints are more vertically (or sagittally) oriented than the typical side-to-side (or coronal) orientation.

– Pathologic spondylolisthesis arises from systemic origins like bone or connective tissue disorders, local issues like infections or tumors or as an inadvertent outcome of a medical treatment.

Other risk factors for spondylolisthesis include having a close relative with the condition, having a curvature in the spine (scoliosis), or having a hidden spina bifida at the level of S1, which is the lowest part of the spine.

Risk Factors and Frequency for Spondylolisthesis

Spondylolisthesis is a condition that usually happens in the lower part of the spine, but it can sometimes occur in the neck area. It’s very uncommon in the middle part of the spine unless caused by an injury. The condition can show up in different forms and can affect different age groups.

Degenerative spondylolisthesis commonly occurs in adults, and affects females more. Overweight individuals are at a higher risk.
Isthmic spondylolisthesis usually develops in teenagers and young adults, but often isn’t noticed until symptoms show up in adulthood. Males are more prone to this form.
Dysplastic spondylolisthesis is more often found in children, and affects females more than males.
Current estimates suggest that by the end of adolescence, 6 to 7% have isthmic spondylolisthesis and up to 18% of adults undergoing spine MRIs show this condition.
The majority of cases, about 75%, involve a minor slippage of the spine, called Grade I spondylolisthesis.
The location where it happens most often is where the spine connects to the pelvis (L5-S1 level). Here, the last bone in the spine (L5) slips forward over the bone below it (S1).
The next most common place for the condition to occur is the level above (L4-5).

Signs and Symptoms of Spondylolisthesis

Lumbar spondylolisthesis is a condition where one of the vertebrae in the lower back slips forward onto the bone below it, causing intermittent and localized lower back pain. Similarly, cervical spondylolisthesis occurs in the neck region and manifests as localized neck pain. The pain from these conditions often gets worse when bending or straightening the spine at the location where the slippage has occurred. The pain can become more intense when the affected area is touched directly.

Additionally, the pain can radiate or spread out because of pressure on nerves due to the decreased space in the spinal column. This happens when one vertebra slides over the other, which can compress the nerve roots exiting the spine.

Sometimes, the pain improves when a person lies flat on their back. This happens because the vertebrae may shift back into a better position, relieving pressure on the spinal structures. However, if the condition isn’t treated, it can lead to additional symptoms like buttock pain, leg numbness or weakness, walking difficulties, and in rare cases, a loss of bowel or bladder control.

Intermittent and localized lower back pain for lumbar spondylolisthesis
Localized neck pain for cervical spondylolisthesis
Pain worsens with bending or straightening of the spine
Pain intensifies when the affected area is touched
Radiating pain due to nerve compression
Pain may improve when lying flat on the back
Possible symptoms can include buttock pain, leg numbness or weakness, difficulty walking
Rare cases can lead to loss of bowel or bladder control

Testing for Spondylolisthesis

If your doctor thinks you may have a condition called spondylolisthesis, where one of the bones in your spine slips out of place, they’ll use a few different types of X-rays to check for it. They’ll take these X-rays from the front-to-back view (anteroposterior) and side view (lateral), and also when you’re bending forward and backward (flexion-extension). They’re looking for any signs that your spine isn’t lined up properly, and whether it moves more than it should when you bend, which can suggest that your spine isn’t stable.

In one specific type of spondylolisthesis, known as isthmic spondylolisthesis, there might be a crack or weakness in a part of your spine, known as the pars interarticularis. This could show up on an X-ray as a “Scotty dog collar” – a dense spot that would be where the collar is on a Scottie dog cartoon. This represents the part of your spine that could be fractured.

Alongside these x-rays, a computed tomography (CT) scan of your spine can provide the most precise diagnosis for spondylolisthesis. Your spine can be viewed more clearly in an image seen from the side (sagittal reconstruction) compared to one seen from the front or back (axial imaging).

Finally, your doctor may do a magnetic resonance imaging (MRI) scan. This can show any abnormalities in the soft tissues around your spine and the discs between your spine’s bones. But it can be more difficult to see the detail of the bones or any potential fractures with an MRI.

Treatment Options for Spondylolisthesis

For patients with grade I and II spondylolisthesis, which is a condition where a bone in the spine slips out of position, the initial treatment usually involves conservative methods. These conservative measures can include pain management drugs like nonsteroidal anti-inflammatory drugs (NSAIDs), application of heat, light exercise, traction – which is a way to pull the bones back into place, wearing a brace, and/or bed rest. However, about 10% to 15% of younger patients with lower severity spondylolisthesis may not respond adequately to these conservative treatments and may require surgical intervention.

There are no set rules for surgical treatment. The surgical options can involve a mix of decompression – a procedure to relieve pressure on the spinal cord, fusion – joining two bones together, fusion with added devices, or interbody fusion – a specific type of fusion surgery involving the vertebrae. Patients whose spine is unstable are more likely to need surgery.

Some doctors propose a procedure that reduces, or moves back the slipped bone if it’s possible. This can not only make the opening where spinal nerves exit wider but also can balance the spine and lower the chance for further wear and tear changes in the spine. However, the process to move the slipped bone back can be more challenging and come with more risks in severe cases or cases where the slipped bone is wedged into the bone below.

There are several conditions that involve problems with the lumbar or lumbosacral region of the spine:

Degenerative Lumbar Disc Disease
Lumbar Disc Problems
Lumbosacral Disc Injuries
Lumbosacral Discogenic Pain Syndrome
Lumbosacral Facet Syndrome
Lumbosacral Radiculopathy
Lumbosacral Spine Acute Bony Injuries
Lumbosacral Spondylosis
Myofascial Pain in Athletes

Frequently asked questions

The prognosis for spondylolisthesis varies depending on the severity of the condition and the individual's symptoms. In general, the majority of cases involve a minor slippage of the spine (Grade I spondylolisthesis) and can be managed with conservative treatments such as physical therapy and pain medication. However, more severe cases may require surgical intervention to stabilize the spine and relieve symptoms.

Spondylolisthesis can be acquired through wear and tear changes in the spine, issues in the pars interarticularis part of the spine, fractures in the pars interarticularis or facet joint structure of the spine, different alignment in the facet joints of the spine, or systemic origins like bone or connective tissue disorders, local issues like infections or tumors, or as an inadvertent outcome of a medical treatment.

Signs and symptoms of Spondylolisthesis include: - Intermittent and localized lower back pain for lumbar spondylolisthesis - Localized neck pain for cervical spondylolisthesis - Pain worsens with bending or straightening of the spine - Pain intensifies when the affected area is touched - Radiating pain due to nerve compression - Pain may improve when lying flat on the back - Possible symptoms can include buttock pain, leg numbness or weakness, difficulty walking - Rare cases can lead to loss of bowel or bladder control

The types of tests needed for Spondylolisthesis include: - X-rays: These are taken from the front-to-back view (anteroposterior) and side view (lateral), as well as when the patient is bending forward and backward (flexion-extension). X-rays help to determine if the spine is properly aligned and if there is excessive movement when bending. - Computed Tomography (CT) scan: This provides a more precise diagnosis by creating detailed images of the spine. A sagittal reconstruction view from the side is particularly helpful in visualizing the spine. - Magnetic Resonance Imaging (MRI) scan: This is used to detect abnormalities in the soft tissues around the spine and the discs between the bones. However, it may not provide as clear detail of the bones or potential fractures compared to other tests.

Degenerative Lumbar Disc Disease, Lumbar Disc Problems, Lumbosacral Disc Injuries, Lumbosacral Discogenic Pain Syndrome, Lumbosacral Facet Syndrome, Lumbosacral Radiculopathy, Lumbosacral Spine Acute Bony Injuries, Lumbosacral Spondylosis, Myofascial Pain in Athletes.

When treating Spondylolisthesis, there can be side effects associated with the conservative methods and surgical interventions. Some potential side effects include: - Conservative methods: - Nonsteroidal anti-inflammatory drugs (NSAIDs) can have side effects such as stomach irritation, ulcers, and increased risk of bleeding. - Application of heat may cause skin irritation or burns if not used properly. - Light exercise may lead to muscle soreness or increased pain if not done correctly. - Traction can cause temporary discomfort or pain. - Wearing a brace for extended periods may lead to muscle weakness or skin irritation. - Bed rest for prolonged periods can result in muscle stiffness, weakness, and other complications. - Surgical interventions: - Decompression surgery may have risks such as infection, bleeding, nerve damage, or spinal fluid leaks. - Fusion surgery can lead to complications like infection, blood clots, nerve damage, or failure of the fusion to heal. - Fusion with added devices may have risks associated with the devices, such as device migration or failure. - Interbody fusion surgery can have similar risks as fusion surgery, including complications related to the fusion site. It's important for patients to discuss potential side effects and risks with their healthcare provider before undergoing any treatment for Spondylolisthesis.

Orthopedic surgeon or spine specialist.

Current estimates suggest that by the end of adolescence, 6 to 7% have isthmic spondylolisthesis and up to 18% of adults undergoing spine MRIs show this condition.

For patients with grade I and II spondylolisthesis, the initial treatment usually involves conservative methods such as pain management drugs, heat application, light exercise, traction, wearing a brace, and/or bed rest. However, about 10% to 15% of younger patients with lower severity spondylolisthesis may not respond adequately to these conservative treatments and may require surgical intervention. The surgical options can involve decompression, fusion, fusion with added devices, or interbody fusion. Patients whose spine is unstable are more likely to need surgery. Some doctors may propose a procedure to move back the slipped bone, which can widen the opening where spinal nerves exit, balance the spine, and lower the chance for further wear and tear changes in the spine. However, this process can be more challenging and come with more risks in severe cases or cases where the slipped bone is wedged into the bone below.

Spondylolisthesis refers to a condition where one of the bones in the spine slips out of place onto the bone beneath it.

Back Pain Degenerative Changes Joint Muscle and Bone Radiculopathy Vertebral Abnormalities