Management of Spondylolisthesis in Elderly People

Introduction

Spondylolisthesis is a condition that occurs when the vertebrae, which is the bone of the spine, slips from its position on the vertebrae present below it. This condition causes pain but can be treated through therapeutic and surgical methods. Proper and regular exercise help to prevent the occurrence of this condition.

What Is Meant by Spondylolisthesis?

‘Spondylos’ means spine or vertebrae, and ‘listhesis’ means slipping or sliding. Spondylolisthesis is a condition that involves the spine where the vertebrae move more than they should move, causing spine instability. The vertebrae slip out from the original position on the lower vertebrae below. This condition increases the pressure over the nerve, which causes lower back pain or leg pain.

Are Spondylolisthesis and Spondylolysis the Same?

Spondylolysis is a condition caused due to stress fracture or crack usually experienced by athletes. Spondylolisthesis is a condition where the vertebrae slip over the one present below. In some cases, spondylolysis can cause spondylolisthesis when the slip of the vertebrae is caused due to stress fracture.

What Are the Various Types of Spondylolisthesis?

• Congenital Spondylolisthesis: This condition occurs in the fetus, where the development of the spine is not proper, and the vertebrae are misaligned, which enhances the risk of spondylolisthesis in later life.

• Ischemic Spondylolisthesis: This condition is caused due to stress fracture called spondylosis. The bone gets weakened due to cracks or fractures.

• Degenerative Spondylolisthesis: This is the most common type, mainly seen in older adults. As the person ages, the water in the disc, which provides a cushioning effect to the vertebrae, loses water. Due to this, there will be thinning of the disc, which causes the vertebrae to slip from their position.

• Traumatic Spondylolisthesis: This occurrence occurs when any injury is the causative factor for disc slipping.

• Pathological Spondylolisthesis: When spondylolisthesis is caused due to some underlying conditions, such as osteoporosis or the presence of a tumor.

• Post-surgical Spondylolisthesis: This condition is caused due to spinal surgery.

What Is Meant by Degenerative Spondylolisthesis?

Degenerative spondylolisthesis usually occurs due to an aging process where the bone, joints, and ligaments weaken and cannot hold the spinal column in position. This condition occurs in people over the age of 50 and is very common in those over the age of 65 years. This condition is more common among females than males. Degenerative spondylolisthesis usually occurs in either of the spinal levels,

• The most common region is L4-L5 at the lower spine.

• L3-L4 level.

This condition rarely occurs in other locations of the spinal cord. If it occurs in the neck, it will be established as a secondary cause of underlying arthritis in the facet joint, which is the connection between the bone and the spinal cord.

What Are the Causes of Degenerative Spondylolisthesis?

Every spinal cord level consists of a disc in the front region and a paired facet joint behind. The disc helps as a shock absorber between the vertebrae, and the facet joint restores the motion. They help in flexion (forward bend) and extension (backward bend) and do not allow much rotation motion. As the person ages, the facet joint becomes incompetent and allows over-flexion making one vertebral body slip over the below one.

What Are the Signs and Symptoms of Degenerative Spondylolisthesis?

Some common signs and symptoms are:

• Backache or leg pain are the common symptoms associated with degenerative spondylolisthesis. Some people may not experience back pain affected by degenerative spondylolisthesis; others may have a primary level of back ache and no leg pain.

• People affected by degenerative spondylolisthesis usually experience sciatic pain, a tingling sensation or pain present in the leg, which is caused due to pressure over the sciatic nerve.

• A tired feeling over the lower portion of the leg on prolonged standing and/or walking.

• Usually, people affected with this condition will not experience much pain while sitting as the spinal canal will be wide open in this position. When upright, the spinal canal decreases in size, causing stenosis and pinching of nerve roots.

How Is Degenerative Spondylolisthesis Diagnosed?

• Medical History: The doctors ask about the signs and symptoms experienced by the person and the condition which improves or worsens the symptoms.

• Physical Examination: The person is examined to check the range of movement, flexibility, muscle weakness, or neurological symptoms.

• Diagnostic Test: Based on the inputs through medical and physical examination, the doctor will recommend an X-ray, which helps to confirm the diagnosis and rule out other causes of the symptoms. Other tests like MRI (magnetic resonance imaging) are recommended based on the X-ray results.

How Is Degenerative Spondylolisthesis Managed?

There are various treatment options; these are

1. Activity Modification: The affected people are recommended to alter their activities to spend more time sitting than standing, which causes pain. Some activity modifications are

• A short rest period, as complete rest for one or two days.

• Long-standing or walking should be avoided.

• Active exercise or any physical exercise should be avoided.

• Activities that involve back bending should be avoided.

If these activities improve the condition and reduce pain, then this can help with degenerative spondylolisthesis in the long term. Small self-care activities like applying cold packs or heating pads and taking over-the-counter medication will help manage this condition.

2. Epidural Injection: For those with severe leg pain, the epidural injection will be the right option for treatment. In almost 50 percent of cases, these injection reduces the pain and helps with functioning. If a single injection does not help the condition, it can be used thrice a year. The time the epidural injection is active depends; it can relieve pain for about a week or a year.

3. Rest: Resting from strenuous activities will help to reduce pain caused due to degenerative spondylolisthesis.

4. Medication: Medications include NSAIDs (non-steroidal anti-inflammatory drugs). These medications help to reduce pain and swelling.

5. Surgical Treatment: Surgery is the last option for managing degenerative spondylolisthesis, where very few people consider surgery a condition that can be managed well with the above non-surgical procedures. Surgery is required for those who want to be more active and function better with reduced pain. If the patient experiences any neurological deterioration, then surgery can be recommended.

Conclusion

Spondylolisthesis is a condition caused due to slipping of the vertebrae over the other vertebrae present below. It results in severe backache and leg pain. Degenerative spondylolisthesis is usually displayed in elderly people. This can be managed through non-surgical and therapeutic methods; in rare cases, a surgical method is recommended.