What is Spondylolisthesis?
Spondylolisthesis is a condition involving spinal instability, meaning the vertebrae in the spine move around more than they should causing them to slip out of normal position. It may put pressure on a nerve, which can cause lower back pain or leg pain.
Spondylolysis and spondylolisthesis are separate yet connected conditions. Spondylolysis usually comes first, though not always. Spondylolysis is the weakness or stress fracture in one of the facet joints, and this weakness causes the vertebrae to slip out of their normal position, resulting in spondylolisthesis.
Spondylolisthesis is rare – it only occurs in about 4-6% of the adult population. However, there are different types of spondylolisthesis that people can have:
- Congenital spondylolisthesis – occurs when a baby’s spine doesn’t form the way it should before birth, causing risk of slippage later in life.
- Isthmic spondylolisthesis – result of spondylolysis where the crack or fracture weakens the bone.
- Degenerative spondylolisthesis – occurs due to aging.
- Traumatic spondylolisthesis – occurs when an injury causes the vertebrae to slip.
- Pathological spondylolisthesis – occurs when a disease or tumor causes the condition.
- Post-surgical spondylolisthesis – slippage because of spinal surgery.
Causes of Spondylolisthesis
There are certain factors that make you more likely to develop spondylolisthesis, including:
- Athletes – stretching the lumbar spine as a result from athletics makes it more likely to develop spondylolisthesis. Overextending the spine is one of the main causes in young athletes.
- Genetics – some people born with spondylolisthesis have a thinner section of pars interarticularis – the thin bone connecting your vertebrae. These thinner areas of vertebrae are more likely to fracture and slip.
- Age – wear and tear of the spine weakens the vertebrae over time and puts you more at risk for spondylolisthesis.
Symptoms of Spondylolisthesis
Some, if not most, people who experience spondylolisthesis do not experience many symptoms, if at all. Low back pain may be present, as well as:
- Muscle spasms in the hamstring.
- Back stiffness
- Difficulty walking or standing for long periods.
- Pain when bending over.
- Numbness, weakness or tingling of the foot.
Diagnosis and Treatment of Spondylolisthesis
Your healthcare provider will perform a physical exam and inquire about your symptoms. Imaging tests may also be needed to confirm the diagnosis. A spinal X-ray will help determine if a vertebra is out of place and an MRI will see if there is soft tissue damage, such as discs and nerves.
Your healthcare provider may recommend noninvasive treatment options before considering surgery. Nonsurgical treatments include:
- Rest
- Medication
- Steroid injections
- Physical therapy
- Bracing
If your provider determines you have high-grade spondylolisthesis, the pain is so severe, and nonsurgical treatments are not helping, surgery may be needed. Surgery will attempt to relieve pain from the irritated nerve, stabilize the spine, and restore function to your spine.
Spinal decompression is the most common form of surgery to treat spondylolisthesis. During this procedure, your provider connects the two affected vertebrae. As they heal, they will form into one bone, eliminating movement between the two.