When a bone in the vertebra slips out of its original position, it causes spondylisthesis. This condition is different from a slipped disc, that occurs when the disc between the vertebrae bones ruptures. In this article, we shall learn more about spondylolisthesis causes, symptoms and its management.
What is Spondylolisthesis?
Spondylolisthesis is a word derived from two different words. This includes spondylo that means spine, and listheises that means slippage. When one of the vertebra slips forward relative to the other, it is called as spondylolisthesis. This condition is more commonly observed in the fifth lumbar vertebra.
Classification of Spondylolisthesis
There are five types of spondylolisthesis, that includes:
1.Isthmic Spondylolisthesis: It is the most common form that occurs due to a slip or fracture of the intravertebral joint. This happens between the age of 6 to 16 years, which goes unnoticed, till adulthood.
2.Degenerative Spondylolisthesis: This condition usually affects the elderly due to arthritis, weakness, ligamentumflavum, etc. Most commonly observed in women over the age of 50 years.
3.Pathologic Spondylolisthesis:This type occurs when there is damage to the bone due to metabolic or metastases bone diseases. It is common during giant-cell tumors, tumor metastases, tuberculosis, etc.
4.Traumatic Spondylolisthesis: A very rare condition that occurs due to neural arch fracture.
5.Dysplastic Spondylolisthesis: Another rare congenital spondylolisthesis type, that occurs due to malformation of the lumbosacral junction.
Symptoms of Spondylolisthesis
Most of the time, spondylolisthesis goes unnoticed as the symptoms are often absent or mistaken as general back pain. Symptoms of spondylolisthesis include:
- General stiffening of the back that causes change in posture
- Tightening of the hamstrings that leads to change in gait
- Lower back pain
- Pain that radiates into hamstring muscles at the back of the thighs
- The person walks with slightly bent knees due to tight hamstrings
- The person develops a leaning-forward posture to compensate the changes
- If a nerve is pressed due to change in position of the vertebra, it can lead to pain that goes right down to the feet, along with tingling and numbness of the feet.
- Sitting and standing up causes a lot of pain
- Coughing and sneezing leads to severe pain in the back
Grade System for Spondylolisthesis
Slippage is graded according to the Meyerding classification.
- Grade I — 1 % to 25 % slip
- Grade II — 26 % to 50 % slip
- Grade III — 51 % to 75 % slip
- Grade IV — 76 % to 100 % slip
Causes of Spondylolisthesis
Spondylolisthesis is usually a hereditary condition. Some are born with a thin vertebra that makes it vulnerable to slippage. At times, one of the parents suffers from spondylolisthesis, leading to spondylolisthesis in their progeny.
People who play aggressive or contact sports are also prone to spondylolisthesis. This is common in weight lifting, football, gymnastics, etc. are at risk of developing spondylolisthesis.
Diagnosis for Spondylolisthesis
An X-ray is helpful in detecting spondylolisthesis. In some cases, to get more detailed images, a CT or MRI scan maybe required.
Treatment for Spondylolisthesis
There are several factors that need to be considered before selecting a specific line of treatment for spondylolisthesis. These factors include the age and overall health of the affected person. Treatment includes:
- Conservative treatment –Use of over-the-counter medications, like, ibuprofen, naproxen, etc. In case of persistent pain, NSAIDs may be prescribed.
One may be given a brace or back support reduce the pain and give support to the lower back. Physical therapy may help in allowing pain-free movements and improve the back flexibility and strength.
- Physical therapy – stabilization exercises help in improving the strength of the back as well as abdominal muscles and minimize the bone movements of the vertebral column.
- Surgery – If the slippage continues and the back pain worsens, one may have to undergo surgical treatment. There are two surgical procedures to help treat spondylolisthesis. These include decompressive laminectomy to remove the bone that is pressing on the nerves. Second, spinal fusion, to help give stability to the spine.
Spondylolisthesis can lead to varying degrees of pain in different individuals. Conservative treatment helps in 80% of the cases and surgery is successful in about 85-90% cases. Maintain a healthy weight and make sure you do not injure or add stress to the spine. If you suffer from any persistent pain in the lower back or have a family history of spondylolisthesis, speak to your doctor and get treated.
Written by: Saptakee sengupta
Date last updated: April 07, 2015