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Spondylolisthesis


Spondylolisthesis

Spondylolisthesis is a condition that affects the spine. It occurs once the vertebrae moves more than it should and slips out of its place. It typically occurs at the base of the spine, however, when the slipped vertebra puts pressure on the nerve, it can lead to pain in the lower back and legs.

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Spondylolisthesis is more likely to occur in cases where you are older, have a degenerative spinal condition, are an athlete, whereas it is more common in children who play football or gymnastics, were born with thinner areas of vertebrae which are more prone to breaking and slipping.

What are spondylolisthesis symptoms?

Some people suffer from spondylolisthesis but don’t experience any symptoms. Symptoms of spondylolisthesis can include:

  • pain in the buttocks
  • muscle stiffness and tightness
  • lower back pain
  • pain that spreads down the legs
  • pain which worsens with activity
  • tight hamstrings
  • difficulties standing or walking

What are the types of spondylolisthesis?

Spondylolisthesis is divided into six main types, which are divided by what causes the condition. The types of spondylolisthesis are:

  • Congenital spondylolisthesis occurs once the vertebra is defective since birth
  • Isthmic spondylolisthesis caused by another condition, referred to as spondylolysis. In spondylolysis, a crack or fracture in the thin area of the vertebra can result in the vertebra slipping forward, backward, or oven the bone below.
  • Degenerative spondylolisthesis is a case of spondylolisthesis, where over time, the disk which cushions the vertebra gets thinner and dries out. This thinning can make it much easier for the vertebra to slip out of place.
  • Traumatic spondylolisthesis is a condition where the injury or trauma leads to a vertebra slipping out of place.
  • Pathological spondylolisthesis is a case where spondylolisthesis is caused by another condition, such as osteoporosis or cancer.
  • Post-surgical spondylolisthesis is a condition that occurs once the vertebra slips out of place after spinal surgery.

Spondylolisthesis is more likely to occur in cases where you are older, have a degenerative spinal condition, are an athlete, whereas it is more common in children who play football or gymnastics, were born with thinner areas of vertebrae which are more prone to breaking and slipping, or those who have a degenerative spinal condition.

How is spondylolisthesis diagnosed?

When your doctor suspects that you might be suffering from spondylolisthesis, you will be asked about the symptoms that you are experiencing and might want to run imaging tests to see whether the vertebra is out of place. Such imaging tests might include:

  • X-ray
  • CT-scan
  • MRI scan

Your doctor might provide you with a grade based on how severe spondylolisthesis is.

Low-grade spondylolisthesis is less serious and typically can be treated with the use of conservative treatment options.
High-grade spondylolisthesis is a more serious condition, which might result in the necessity of a surgical procedure.

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How to treat spondylolisthesis?

Spondylolisthesis treatment might include:

  • Physical therapy to strengthen the supportive back muscles and abdominal muscles.
  • Resting
  • Anti-inflammatory medicines, such as naproxen and ibuprofen,
  • Steroid injections can be used as a more powerful anti-inflammatory option, which can help to provide symptom relief and is injected directly into the affected area.
  • Bracing

However, if you continue with a combination of all conservative treatment options and you still feel spondylolisthesis symptoms, it might be necessary to get surgery.

A surgical approach might involve the removal of the bone and disk from the spine, which can provide your nerve with more room and can stop the pain. This procedure is other referred to as spinal decompression. Next, your surgeon might need to fuse your affected vertebra, as this can help to prevent them from slipping again.

Does spondylolisthesis lead to complications?

Severe cases of spondylolisthesis can lead to another condition sometimes, referred to as cauda equine syndrome.

It is a very serious condition, during which nerve roots of the lower back, known as cauda equina, get compressed. This can lead to a loss of feeling in the legs and can also affect the bladder. It should be considered a medical emergency, as when left untreated, it can lead to loss of bladder control and even paralysis.

Can you reduce my risk of spondylolisthesis?

There are some steps that you can take to reduce the risk of spondylolisthesis. These steps include:

  • maintaining a healthy weight as the additional weight can put added stress on the lower back
  • doing exercises that can strengthen the abdominal muscles and back muscles
  • eating a well-balanced diet to keep the bones strong and well-nourished

If you have already suffered from spondylolisthesis, you must continue strengthening the back and abdominal muscles with exercises. You must have regular checkups, as the healthcare provider is then able to detect any future issues early on. The chance of spondylolisthesis recurring is higher, in cases where you’ve suffered from a high-grade spondylolisthesis. For people who have rather had a minor slippage, the condition might never recur.

What is the outlook for spondylolisthesis?

Conservative treatment options of spondylolisthesis cannot reverse a crack or slippage, however, they can help to manage pain symptoms. If surgery is necessary, it can relieve the pressure that is being put on the nerves, can stabilize the vertebrae, and can restore the strength of the spine.

When you suffer from pain due to spondylolisthesis, you must take a break from strenuous exercises and activities. Over-the-counter medications can help to relieve pain and inflammation.

Although spondylolisthesis is a very common cause of back pain, it is not to be seen as a dangerous condition and it doesn’t need to stop you from being able to go on with your daily activities. There are many available treatment options from it. You must speak to your healthcare provider if you suffer from symptoms of spondylolisthesis. There are cases, where spondylolisthesis can come back. This however is more commonly the case in patients who have suffered a high-grade spondylolisthesis. Even patients who have suffered from surgery, can recover from it and get back to their normal activities within a couple of months after the surgery. Some patients can however notice, that the spine won’t be as flexible as it used to be before.

References:
https://www.ncbi.nlm.nih.gov/books/NBK430767/
https://www.ncbi.nlm.nih.gov/books/NBK448122/
https://www.ncbi.nlm.nih.gov/books/NBK513333/
https://www.pennmedicine.org/updates/blogs/neuroscience-blog/2017/december/spondylolisthesis

DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general information. In no way does any of the information provided reflect definitive treatment advice. It is essential to consult a best-in-class pain management specialist in New York regarding ANY questions or issues. A thorough evaluation should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call your pain doctor to schedule a consultation.

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  • Dr. Raj Raval, M.D.

    1. Board Certified
    2. Interventional Pain & Musculoskeletal Medicine Specialist
  • Education & training

    1. SUNY Downstate PMR Residency
    2. Rutgers University Fellowship
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