Spondylolisthesis is a spinal disorder that generates lower back aches. A vertebra may slip out of place onto the underlying vertebra. It may compress a nerve. This leads to lower back or leg pain. The term spondylolisthesis originates from the Greek words spondylos, meaning spine, and listhesis, which means slipping, sliding, or movements.
Are Spondylolisthesis and Spondylolysis Different?
Both spondylolysis and spondylolisthesis result in lower back pain. They are related to an extent but not identical.
Spondylolysis: This spine defect results in a stress fracture or crack in spine bones and is commonly seen in athletes.
Spondylolisthesis: This condition is characterized by a vertebra slipping out of place and resting on the bone below it. Spondylolysis may sometimes be a cause of spondylolisthesis, for instance, in case of stress fractures that cause the slipping of the bones. The vertebra may also slip out of place due to degenerative conditions. The disks in between vertebrae and the facet joints wear down over time. The bones of the facet joints grow back and may also overgrow. This causes an uneven and unstable surface area. It makes the vertebrae less stable. Regardless of the cause, when the vertebrae do slip out of place, it pressurizes the bone below it. Most cases of spondylolisthesis are asymptomatic.
What Are the Types of Spondylolisthesis?
There are a few common and uncommon variants of spondylolisthesis that include the following;
Congenital Spondylolisthesis: The condition occurs when a baby’s spine does not form the way it should before birth. The mal-aligned vertebrae put the individual at risk for slippage later in life due to exertion or just normal wear and tear.
Isthmic Spondylolisthesis: It is the condition that is caused due to spondylolysis. It occurs when a crack or a fracture weakens the bone.
Degenerative Spondylolisthesis: It is the commonest type of spondylolisthesis. It occurs as a result of aging. With time, the aging disks that cushion the vertebrae lose water and thin out. The thinning disks are more likely to slip out of place.
The lesser occurring variants of spondylolisthesis include the following;
Traumatic Spondylolisthesis: As the name suggests, it is caused when an injury causes vertebral slippage.
Pathological Spondylolisthesis: It is attributed to diseases such as osteoporosis or tumors that result in compression and slippage of the bones in the spine.
Post-surgical Spondylolisthesis: It is a complication of a poorly performed spine surgery.
How Commonly Does Spondylolisthesis Occur?
The incidence of both spondylolisthesis and spondylolysis is about four percent to six percent of the adult population. It is highly possible to live with spondylolisthesis for years as it may never show symptoms such as pain or numbness.
Degenerative spondylolisthesis is more commonly seen after 50 years and affects women more than men.
In teens, isthmic spondylolisthesis is more common, especially in those associated with athletics.
What Are the Risk Factors Behind Spondylolisthesis?
Although spondylolisthesis may occur in almost anyone, the following factors may make an individual more prone to it;
Athletics: Young athletes, especially children and teens, participating in sports experience stretching of their lumbar spine. Activities such as gymnastics and football are more likely to cause spondylolisthesis. Vertebral slippage occurs mostly during children’s growth spurts. The condition is one of the most common reasons for back and leg pain in teens.
Genetics: Some people have a genetic predisposition to isthmic spondylolisthesis. They are born with a thinner section of the vertebra. This is known as pars interarticularis. The thin piece of bone that connects the facet joints links the vertebrae directly above and below. This forms a working unit that permits spine movement. The thinner areas of the vertebrae are more likely to fracture and slippage. Degenerative spondylolisthesis also has a high genetic predisposition.
Age: With age, degenerative spine conditions can develop. It is when wear and tear on the spine result in the weakening of the vertebrae. Older adults with pre-existing degenerative spinal conditions are at higher risk of developing spondylolisthesis, and it becomes more common after age 50.
What Are the Grades of Spondylolisthesis?
There are several grades of spondylolisthesis;
Low-grade: This involves grades I and II. These grades do not usually require surgical intervention. Such cases are usually seen in adolescents with isthmic spondylolisthesis. All cases of degenerative spondylolisthesis also depict similar grades.
High-grade: This involves grades III and IV. It may require surgery if the patient experiences excruciating pain.
Is Surgery Necessary to Treat Spondylolisthesis?
The treatment usually begins with non-surgical options. This includes rest and physical therapy. These treatments are palliative and often help to relieve the symptoms. Surgery is recommended under the following conditions;
What Are the Causes Behind Spondylolisthesis?
In young athletes, overextending the spine is a principal cause of spondylolisthesis. Genetics also has a major role. Some people have congenital thinner vertebral bones. In older adults, degeneration causes wear and tear on the spine and discs.
How Does Spondylolisthesis Feel Like?
Spondylolisthesis may be asymptomatic and present no significant feelings for a patient. Some individuals who have the condition don’t even know it and may never know throughout their lives. Lower back pain is typically the most common symptom, which may extend to the buttocks and down the thighs.
There are several other symptoms enlisted as follows;
Hamstring muscle spasms.
Difficulty walking or standing for long periods.
Pain when bending over.
Numbness, weakness, or tingling in the foot.
How Is Spondylolisthesis Diagnosed?
After a physical examination, the consulting physician may recommend a few diagnostic imaging studies to arrive at a final diagnosis.
How Is Spondylolisthesis Managed Nonsurgically?
The non-surgical treatment modalities for spondylolisthesis include the following;
Rest: Taking a break from strenuous activities and sports that caused the condition in the first place.
Medication: Over-the-counter Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used. These include Ibuprofen or Naproxen, causing relief of the symptoms. In cases of extreme pain, Opioids may be prescribed.
Injections: Steroid medications may be directly injected into the affected area.
Physiotherapy: A physical or occupational therapist can teach the individual targeted exercises. This helps to strengthen the patient's abdomen and back. Daily exercise routines often result in pain relief after a few weeks of following the regimen.
Bracing: A brace helps to stabilize the spine. These braces limit the movement of the spine. This helps fractures to heal. Braces, however, are not recommended in adult patients.
When Is Surgery Necessary?
Surgery is recommended when the pain is severe and cannot be managed by conventional and non-surgical methods of management. The aim of the surgery is:
To relieve pain from the irritated or compressed nerve.
Stabilization of the spine where vertebral slippage has occurred.
Restoring the normal functionality.
Does Spondylolisthesis Recur?
Usually, the pain goes away after recovery from surgery. The patient can gradually begin to resume their regular activities until full function and movement have been regained.
Spondylolisthesis is usually an asymptomatic condition. However, some conditions may cause excruciating pain and require medication, therapy, or surgery. A consultation with a specialist is highly recommended in such cases. The condition usually does not recur.