The spine is made up of a series of interconnecting bones called vertebrae that form the spinal column - the main support structure for the body that keeps it upright and balanced. Other functions of the spine include:
- Providing platforms for attachments of many muscles and ligaments that traverse the skull, the thorax, and the pelvis
- Permitting the trunk of the body to have appreciable flexibility of movement, such as twisting, bending, or arching the back
- Protecting the spinal cord while providing openings between adjacent vertebrae for the passage of spinal nerves.
Spondylolisthesis occurs when one vertebra slips over the vertebra just below it. Though it can occur at the level of cervical vertebrae, it occurs most often at the level of the lumbar vertebrae. Symptoms can range from none at all to severe symptoms with pain and weakness in the legs. Slippage may result in lordosis ("swayback") or kyphosis ("roundback"), a backward curve of the spine at the lower back where L5 (the fifth lumbar vertebra) slips over the sacral promontory. Most cases of spondylolisthesis are not severe and do not involve high levels of slippage. The severity of spondylolisthesis is determined by the degree of slippage observed on X-rays.
Spondylolisthesis can be caused by various conditions, but the symptoms are basically similar and include:
- Lower back pain
- Stiffness in the back
- Localized pain or tenderness in the back just above the pelvis
- Tight hamstrings
- Pain in the thighs and legs (radiculopathy)
- Pain in the buttocks
In general, there are several types of spondylolisthesis based on the underlying cause of the vertebral slippage:
- Dysplastic or congenital - caused by a malformation in the baby's spinal column before birth
- Isthmic - caused by a defect or fracture of the bone that connects the upper and lower facet joints of a vertebra
- Degenerative - caused by degeneration of the facet joint due to aging and normal "wear and tear"
- Traumatic - caused by an injury to the spinal column
- Pathological - caused by an underlying pathological disorder such as cancer or bone disease
- Iatrogenic - caused by a previous surgery to the spine
Most patients with low-grade spondylolisthesis are asymptomatic. The clinical course of the condition is generally benign regardless of age. High-grade spondylolisthesis is thought to occur in 5%-10% of cases of spondylolisthesis. It typically develops during childhood or adolescence and is associated with a high risk of progression. Adults who are diagnosed with high-grade slippage are typically stable and rarely experience further progression of slippage. Slip progression after skeletal maturity is usually related to disk degeneration secondary to osteoarthritis at the slip level. This is likely to develop during the fourth and fifth decades of life with the onset of degenerative spondylolisthesis.
The diagnostic evaluation for spondylolisthesis includes a patient history, a physical examination, and radiological imaging studies. There are numerous reasons that a person may experience back pain and these must be ruled out before the relationship between back pain and spondylolisthesis can be established.
Other causes of back pain may include:
- Lumbosacral strain - strain of the muscles or ligaments of the lower back that typically appears as sudden lower back pain
- Radiculopathy caused by compression or irritation of the nerve roots due to degeneration or herniation of the intervertebral disk
- Intermittent claudication due to either vascular insufficiency (which reduces blood circulation to muscles during walking) or to neurologic causes (e.g., peripheral neuropathy)
- Poor muscle tone and spinal alignment
- Juvenile osteoporosis
- Osteosarcoma (bone cancer)
- Congenital hypoplasia of the spine - incomplete development of any part of the spine.
The primary goals of treatment for individuals with spondylolisthesis include:
- Relieving pain
- Restoring spinal flexibility and function
- Stopping the progression of slippage
There are two basic categories of treatment options for spondylolisthesis:
- Conservative treatment
- Surgical treatment
Conservative treatments for spondylolisthesis include:
- Lifestyle modifications
- Physical therapy
- Drug therapy
Surgery for spondylolisthesis is recommended if conservative therapy has not been effective, symptoms progress, and unremitting pain leads to a significant disruption in quality of life.
The goals of spondylolisthesis surgery include:
- Relieving pressure or compression of the affected nerves
- Stabilizing the vertebrae with fusion to prevent further slippage and nerve compression
- Restoring spinal alignment and function
Spondylolisthesis can have a significant impact on function and quality of life due to pain and restrictions on activity. This can be especially frustrating for young and active individuals.
Some suggestions that may be helpful in minimizing the risk of further slip progression in both children and adults with spondylolisthesis include:
- Maintaining an ideal weight
- Muscle strengthening exercises
- Education regarding daily living activities such as learning how to bend properly
- Education regarding the condition and its treatment options is very important for providing the individual with a sense of control, as well as important information required to make informed treatment decisions.
The Medifocus Guidebook on Spondylolisthesis is a unique, comprehensive patient education resource that contains vital information about Spondylolisthesis that you won't find anywhere else in a single resource. The Guidebook will answer many of your questions about this condition that your healthcare provider may not have the time to answer. To learn more about the Guidebook, please click here