A Patient’s Guide to Spondylolisthesis
Lumbar spondylolisthesis is a spinal condition in the low back where one vertebra in the spinal column slips out of place and remains out of alignment with relationship to another vertebra. This “slipped vertebra” can cause significant pain in many individuals who are afflicted with this condition. This should not be confused with a “slipped disc,” which is a different condition.
There are several types of lumbar spondylolisthesis, which originate from different causes, and these include:
- Degenerative Spondylolisthesis – This is the most common type and is the result of the natural aging process, wear and tear, degenerative disc disease, and arthritis in the spine.
- Congenital Spondylolisthesis – This occurs prior to birth in utero. Those babies’ spines do not develop correctly, and that leaves those individuals at a higher risk for developing a slipped vertebra later in life.
- Isthmic Spondylolisthesis – This stems from a small stress fracture that develops within a part of the vertebra known as the pars interarticularis. Also known as “spondylolysis,” this stress fracture occurs most typically at the L5-S1 level and is another common cause of spondylolisthesis or vertebral slippage.
- Traumatic Spondylolisthesis – This occurs most typically after major high-energy trauma to the spine, which causes a vertebra to slip on another.
- Pathological Spondylolisthesis – This variant develops from a disease or tumor within the spine.
- Post-Surgical Spondylolisthesis – This may occur in some patients post-operatively after undergoing spinal surgery.
What is the Difference Between Spondylolysis and Spondylolisthesis?
Patients often confuse spondylolisthesis with spondylolysis. Spondylolysis and spondylolisthesis are related conditions, and both are common sources of low back pain. While related, spondylolysis refers to a crack or stress fracture in one of the vertebrae. This fracture, near the facet joint in an area known as the pars interarticularis, can then progress to spondylolisthesis, where a vertebral bone slips forward out of its normal position. Spondylolysis is usually caused due to repetitive microtrauma that leads to fatigue fractures in these locations. Spondylolysis can manifest on one side (unilateral) or both sides (bilateral) and at any level of the spine, but most commonly occurs at L5 in the lumbar spine.
What is the Difference Between a Slipped Disc and a Slipped Vertebra?
A slipped disc is the same as a herniated or ruptured disc. Think of a disc as being like a jelly donut. A slipped disc is when the jellylike cushioning material in the central portion of the disc pushes through the outer wall of the disk, which can then place pressure on a nerve, which can cause pain and other symptoms. A slipped vertebra or spondylolisthesis is when one vertebral bone slips forward on an adjacent vertebra and remains out of its proper position and can cause pain and other symptoms as well. Furthermore, a patient may experience a slipped disk and a slipped vertebra concurrently.
What are the Most Common Symptoms of Spondylolisthesis?
Symptoms of spondylolisthesis are often dependent on the severity of slippage. Since every patient is unique, some patients with spondylolisthesis may remain completely asymptomatic, while others may feel debilitating pain. Patients with spondylolisthesis may experience any combination of the following symptoms:
- Stiffness and pain in the low back
- Radiating pain in the lower extremities in the buttocks, down the thighs, and into the legs and feet
- Numbness, weakness, and/or spasms in the lower extremities
- Difficulty walking or standing for even short periods
- Pain when bending over and with increased activities
Is Spondylolisthesis Serious?
Like other medical conditions, there are varying levels of severity of spondylolisthesis and patients’ symptoms vary as well. Until a trained orthopedic doctor can examine the patient and make a diagnosis, it is difficult to know exactly how severe and serious the spondylolisthesis might be.
How Do You Evaluate and Treat Spondylolisthesis?
A thorough history and physical examination followed by X-rays and possibly even MRI and CT radiographic imaging studies will help your spine doctor assess the severity of the spondylolisthesis. There are 5 grades of severity. In Grade I and Grade II Spondylolisthesis, the spinal slippage is less severe, and in most of these cases, a board-certified spine surgeon will recommend nonoperative treatment.
Nonsurgical treatment for symptomatic spondylolisthesis could include any combination of the following:
- Rest and avoiding strenuous activities
- Physical therapy to strengthen the muscles in the stomach and back
- Over-the-counter medications, such as NSAIDs, or prescribed medications
- Epidural steroid injections
- Bracing to help stabilize the spine
When the pain and other symptoms from spondylolisthesis become unmanageable with these nonoperative treatment measures, your orthopedic spine surgeon may recommend surgical intervention. Surgery may also be considered for patients in pain with higher grades of vertebral slippage. Patients with Grades III, IV, and V of vertebral slippage often respond less favorably to non-surgical treatments.
Correctly executed surgery for spondylolisthesis has a high success rate and typically involves decompression of the compressed and irritated nerve roots and often also includes a fusion of one vertebra to another. This means that the spine surgeon will remove the bone and disc from the spine to give the nerve more space and will create an environment that will allow one vertebral bone to heal and fuse to another.
The goals of surgery for spondylolisthesis include:
- Relieve nerve root compression and irritation
- To stabilize the spine
- Restoration of function and mobility
What Happens if Spondylolisthesis is Left Untreated?
If spondylolisthesis is left untreated, the vertebrae may continue to slip, which may cause greater nerve compression with increased pain, stiffness, muscle spasms, and numbness. This can also possibly lead to permanent nerve damage, resulting in permanent muscle weakness and paralysis. If you notice an onset of spondylolisthesis symptoms, it is important to visit a qualified spine doctor who can provide you with the correct diagnosis and an appropriate treatment plan to avoid these serious complications.
Seek Spondylolisthesis Treatment at NJSS
The award-winning spine surgeons of New Jersey Spine Specialists welcome the opportunity to provide new and existing patients with the best treatment options to help alleviate back pain, whether through medication, therapy, and non-surgical procedures. To receive a consultation and diagnosis for your spondylolisthesis, contact the board-certified doctors at New Jersey Spine Specialists today.
With a staff of nationally recognized spinal care experts and spine surgeons in both their Summit and Montclair offices, the board-certified doctors at New Jersey Spine Specialists can help. Our compassionate team will take the time necessary to listen and work diligently to understand your symptoms. Call (908) 608-9619 today for expert advice to effectively treat your spondylolisthesis.
*Spine Health: https://www.spine-health.com/conditions/spondylolisthesis/degenerative-spondylolisthesis