Spondylolisthesis is defined as the displacement or slippage of one of your vertebra compared to another or all others(33). It is a condition that occurs when your vertebra (the bone in your back) slides forward and over the bone below it.
Spondylolisthesis is derived from two words: "spondylo" meaning spine, and "listhesis" meaning slippage, so essentially the definition of Spondylolisthesis is the slippage of the spine. Although the literal Spondylolisthesis definition is the slippage of the spine, medical dictionaries use the Spondylolisthesis definition of forwarding slippage of one of your vertebra.
Spondylolisthesis commonly occurs in the lumbosacral area or in the lower part of your spine. Commonly, Spondylolisthesis can lead to your spinal cord or nerve roots being compressed, causing immense pain and numbness in your back, which can radiate to your legs.
The 2 Types of Spondylolisthesis
There are two types of Spondylolisthesis, classified by the way they are acquired or the way they are caused. These two types are:
- Developmental Spondylolisthesis – Developmental Spondylolisthesis, the first type is one that is present at birth or one that may be acquired during childhood. This type of spondylolisthesis is not easily noticeable until later in childhood or once the person has reached adulthood.
- Acquired Spondylolisthesis – As the name suggests this type of Spondylolisthesis is acquired past childhood and can be acquired in two ways:
- Constant everyday wear and tear on your spine – The connections in your vertebrae may weaken due to the everyday activities that you do, including carrying heavy things and doing a strenuous physical activity that puts stress on your spine may lead to spinal degeneration and Spondylolisthesis.
- Trauma or Injury to the spine – Acquired Spondylolisthesis can also be caused by forced trauma or injury to the spine. For example, the force applied to your spine when falling on your back or landing on your feet from a great height. Other sports like American football which causes continuous force being applied on your back can also cause acquired Spondylolisthesis.
Spondylolisthesis Degrees of Severity
Spondylolisthesis can also be classified according to the degree of slippage of the vertebra, and its severity. Spondylolisthesis classified this way has 5 grades and is measured by how much the vertebra has slipped forward over the vertebra beneath it. The 5 different grades and their degree of slippage are listed below:
- Grade 1 – About 25% of the vertebra has slipped forward
- Grade 2 – 25%-50% of the vertebra has slipped forward
- Grade 3 – 50%- 75% slippage
- Grade 4 – 75%-100% slippage
- Grade 5- 100%, this is the highest degree of slippage among the grades and means that the vertebra has completely fallen off, resulting in Spondylolisthesis.
What are the Causes of Spondylolisthesis?
Spondylolisthesis is caused by a variety of different factors, as the forward slippage of your vertebra can be a result of one or more factors.
Spondylolisthesis is caused when the small joints in your spine that line up the bone encounters a problem that moves it out of line. These small joints in the back could encounter any problem listed below that may cause spondylolisthesis:
- A congenital defect in one of the small joints in your vertebra
- Damage or previous injury to any one of the small joints in your vertebra
- Anyone of these small joints encountering a stress fracture caused by overuse and pressure
- An infection due to arthritis that causes joint damage
Excessive strain on the vertebra on your back can also be a cause of Spondylolisthesis. A good example of activities that produce strain on your vertebra includes certain sports such as weightlifting, American football, and gymnastics. Similarly, continuous lifting of heavyweights can also be a cause of Spondylolisthesis.
There are also classifications of Spondylolisthesis based on what caused the condition in the first place. Some of these causes are:
- Degenerative – Spondylolisthesis can be caused by the gradual degeneration of the cartilage and other soft tissues in the small joints of your vertebrae. Degenerative Spondylolisthesis is common in elderly as a result of Osteoarthritis.
- Traumatic- Spondylolisthesis can also be caused by previous trauma caused by an injury to the spine or any body part directly in contact with it.
- Post-surgical- Spondylolisthesis can also be caused by complications right after surgery of the spine from any other condition that is related or not related to Spondylolisthesis.
Risk Factors Associated with Spondylolisthesis
The risk factors involved with Spondylolisthesis include:
- Having a family history of back-related problems
- High impact sports
- Having a history of repetitive back trauma
- Having a history of hyperextension of the lower part of your spine
What are the most common spondylolisthesis symptoms you need to look out for?
Spondylolisthesis symptoms are generally hard to keep track of in its early stages as it does not exhibit specific symptoms and most often, the people who have Spondylolisthesis will know about this condition by getting an x-ray for a different bone-related problem.
However, in the rare cases that Spondylolisthesis symptoms will show, it can manifest itself in various ways such as:
- Pain that can be felt in the back and in your buttock - This is one of the most common Spondylolisthesis symptoms out there and is the one symptom most people feel first. Spondylolisthesis tends to cause this problem, and your back will feel like it is stiffening, and the hamstrings in your buttock will also tighten.
- Change in Posture and Gait - often this Spondylolisthesis symptom goes hand in hand with the previous symptom, as the change in posture and gait will be felt after the stiffening of your back and buttock happens
- Pain that radiates from your lower back down to your legs - In most Spondylolisthesis symptoms, the pain will only be felt in the lower back as this is the origin point, but sometimes, the pain radiates towards one or both of your legs.
- Numbness and Weakness in the Legs – Another Spondylolisthesis symptom related to the leg is a result of one of your vertebra moving forward, and when that happens you will feel a certain numbness or weakness in your leg, in addition to pain.
- Walking will be Difficult - along with the two Spondylolisthesis symptoms mentioned above, you will have difficulty walking and might not be able to or perform or have difficulty performing everyday tasks.
- Worsening of Pain upon Bending or Twisting - when you do tasks that require you to twist your body to one side or require you to bend over, you may notice that the pain will get instantly worse, and will feel like a shooting pain that radiates through your lower back, legs, and buttocks.
- Changes in the Way You Walk – People that are affected with Spondylolisthesis will most definitely develop a change in the way they walk to compensate for the change in posture and the pain they may feel in their lower back. The most common style of walking that develop due to Spondylolisthesis symptoms is waddling.
- Changes in Posture - Just like the previous Spondylolisthesis symptom, your posture may change to a more leaning-forward type of posture.
- Loss of bladder or bowel control - this is a rare symptom of the condition and may happen in the most severe cases.
Medical Procedures used to Diagnose Spondylolisthesis
After feeling the Spondylolisthesis symptoms listed above, see your physician to get an examination to see if you have Spondylolisthesis or any other underlying back problem. The sooner the diagnosis, the better. In some cases of the condition, the Spondylolisthesis symptoms will not be present, and the condition itself is diagnosed via diagnostic procedures of another back-pain related problem.
- X-rays - X rays are perhaps the first thing the doctor will require if they suspect you have spine related problems or if you are experiencing Spondylolisthesis symptoms. X-rays can show if any vertebra in your back is out of place, or if it has fractures and cracks that are also a cause for concern. Two types of x-ray can be done to you, and the first one is a lateral x-ray, where you will stand facing the side so the doctor can get a clear view of your spinal cord and if any vertebra within it has slipped out of place. The second one is an oblique x-ray, which is done from an angle. An oblique x-ray is useful for seeing the lamina, and facet joints of your spinal cord.
- CT Scan - just like x-rays, computerized tomography or CT scans can also be helpful in determining if you have Spondylolisthesis or not. CT scans offer a much clearer view than x-ray and are good for cross-sectional views of your spinal column.
- MRI - Just like the CT scan and X-ray, Magnetic Resonance Imaging or MRI is also an effective imaging tool that provides a clear view of any defects or complications in your spinal cord.
- Myelogram - A myelogram involves having the doctor numb your lower back, or the body part in question, and inject a special dye around your nerves. You will then be subjected to an imaging test such as an x-ray or a CT scan.
How is Spondylolisthesis Treated in Most Cases?
Spondylolisthesis Treatment can involve numerous factors that the doctor must take into consideration, such as the age and health of a person, in other words, their overall surgery risk, as well as the extent or grade of the slip and how severe the symptoms are.
As far as Spondylolisthesis treatment is concerned, doctors strive for the treatment to be conservative. Conservative treatment involves medication, rest, exercise and physical therapy. However, in some cases where the degree of Spondylolisthesis is already severe and the surgery risk of a person is low, a surgical option is recommended.
Here are some of the most common Spondylolisthesis treatments used:
1. Conservative Treatment - this is always the primary recommendation of most doctors when it comes to Spondylolisthesis treatment. This type of Spondylolisthesis treatment involves letting the person rest from all strenuous activities that have caused the condition in the first place, and may cause the condition to exacerbate further. Conservative Spondylolisthesis treatment also involves the use of medications such as:
- NSAIDs: Nonsteroidal anti-inflammatory drugs are prescribed by the doctor in conservative Spondylolisthesis treatment as these medications can help control and subside the pain and inflammation felt by the patient. A few examples of NSAIDs are ibuprofen, acetaminophen, and naproxen sodium.
- Epidural Steroid Injections: in the case that NSAIDs won’t work in Spondylolisthesis treatment, a stronger medication such as an Epidural Steroid Injection might be prescribed by the doctor. This type of medication is injected directly into the area immediately surrounding the spine, and can effectively reduce swelling and pain.
2. Braces and Supports: this type of Spondylolisthesis treatment can be an accompaniment to the conservative treatment prescribed by your doctor or it can be the treatment all on its own. Braces and supports help retain posture and stabilize your lower back as well as your buttocks and legs. Braces also effectively reduce the pain you are feeling and will allow for pain-free movement and improve your condition.
3. Physical therapy: this is also a Spondylolisthesis treatment that goes hand in hand with the two previous methods or can be an effective treatment and itself as well as an aftercare activity to regain movement and muscles. The physical therapy done as a treatment involves the exercising of the abdominal and back muscles, all while minimizing the strenuous movement of the spine. This treatment, coupled with medication and/or surgery can help achieve significant clinical improvement for the patient.
4. Surgery: if the vertebra in your spinal column continues to persist with its slippage, progressively worsening your condition along with the symptoms you are feeling, then a surgery is the most logical option for you to undertake. Surgical Spondylolisthesis treatment is mostly used for last resort cases, such as when medication and conservative treatment does nothing to lessen the pain and symptoms of the condition. The doctor will take into consideration your overall health and your age to assess your surgical risk before advising you to undergo this treatment.
If you finally decide to move forward with this type of Spondylolisthesis treatment, then there are two types of surgery that the doctor can prescribe you based on your situation:
- Decompressive Laminectomy: this is done by removing part of the vertebra that is pressing on your nerves, causing pain. This is usually not chosen as although removing a part of your vertebra can relieve the pain, it might cause the spinal cord to become unstable.
- Spinal fusion: this is the second surgical procedure and involves a bone being transplanted to a strategic location at the back of your spine where the slippage is located. When the bone heals, it gradually fuses with your spine, improving the stability of your vertebrae and effectively improving the condition. In this process, rods and screws are often used until the transplanted bone heals and fuses with the spine.
Can Spondylolisthesis be Prevented?
Spondylolisthesis is not exactly a preventable condition, as you might not even know that you are at risk of having it or if you might actually have it now. But there are steps you can take to reduce your chances of having Spondylolisthesis in the future:
- Keeping and maintaining a good posture is important to avoid gradual slippage of a vertebra, as well as to avoid any other spine related problems.
- Avoiding sports that put too much stress and pressure on your lower back, and your back in general.
- Constant exercise to keep your muscles and bones fit, especially the muscles in your back and abdomen, which can help to effectively support and stabilize your spine.
- Eating well can help you attain a healthy body size, thus avoiding excess weight which causes undue stress on your lower back.