The term spondylolisthesis is derived from two Greek words put together; spondylos, which means “spine or vertebra”, and “listhesis”, which means to “slip or slide”.
Spondylolisthesis is a spine condition that develops when a vertebra in your spinal column slips out of its place or gets misaligned.
In case a vertebra slips or slides out too far, direct pressure could fall on one of the spinal nerves and result in pain in the lumbar regions of the back, and weakness in the legs that may also be accompanied by a numbing sensation.
In some rare cases, patients also experience severe symptoms like bladder and bowel control. It is important to seek professional medical care immediately if any of these symptoms become apparent.
What Causes Spondylolisthesis?
The human vertebral column consists of the vertebrae, joined together one on top of the other by small joints on either side, called the facets.
These facets support the spinal functional and allow for smooth movement like bending, twisting and turning. Weakening and degeneration of these joints result in Spondylolisthesis. This condition may develop due to several different reasons, some of them include:
- Presence of a defective facet joint since birth (also known as congenital)
- Damaged or trauma caused to a facet joint
- Overusing the facet joint
- Arthritis or infection
Teenagers and young adults involved in vigorous physical activities like high impact sports are also at the risk of developing the condition.
Overuse and high impact activities can lead to the exertion of extra stress and pressure on the backbone and cause fractures in the vertebrae, resulting in Spondylolisthesis. In the older population, natural wear and tear of the bones and joints are generally the cause behind these fractures.
Although fractures are a serious cause of spondylolisthesis, it is not necessary for them to be present for the condition to develop. Problems like the weakening of the ligaments connecting the vertebrae together can also allow slippage and lead to spondylolisthesis.
The progress of the condition is represented by grades according to how much one vertebra slips in comparison to the other. The grades are defined in the following:
- Grade I – <25%
- Grade II – 25–50%
- Grade III – 50–75%
- Grade IV – >75%
- Grade V – One vertebra has fallen off the next, completely
Symptoms of Spondylolisthesis
Even though it is not unusual for a person with Spondylolisthesis to never experience any symptoms, the most common ones include:
- Pain that starts in the lower back and radiates down one or both legs.
- A numbing sensation or muscle weakness in one or both legs
- Difficulty in walking
- Pain in the lumbar back or buttock region that worsens with certain physical activities such as bending or twisting
- Loss of bladder or bowel control.
Spondylolisthesis: Its Diagnosis and Treatment
Getting started with treatment usually involves cutting down on or stopping any physical activities which may have led to the condition.
This first step is accompanied by anti-inflammatory medication for example ibuprofen to help manage the pain and help the inflammation.
The next step of the treatment plan is usually physical therapy guided by a professional therapist.
The physical therapy routines recommended for the treatment of spondylolisthesis include exercises that strengthen the core, the abdomen and muscles in the lumbar back region and helps build stability in order to avoid chances of further damage.
In case the patient is obese or overweight, a good option to consider would be to focus on weight loss.
If the slippage continues to worsen or the pain persists, surgery is usually recommended. Endoscopic procedures can help decompress the facet joints and central areas of the lamina bones to relieve the pain associated with it.
Here are some benefits of endoscopic surgery:
- ¼ inch incision
- Conscious sedation
- Return to work sooner than minimally invasive or traditional spine surgery
- Minimal recovery time
When there is no need for Endoscopic surgery and the patient’s condition continues to deteriorate, traditional laminectomy may be used to decompress. In certain cases, a fusion may be used to stabilize the facet joint and vertebrae.
Post-surgery, the patient will be asked to wear a back brace for some time to assist with the recovery phase. They may also have to refrain from carrying heavy items.
Rehabilitation therapy is imperative to strengthen the core abdominal and back muscles.