What is spondylolisthesis?
Spondylolisthesis is a spinal condition that occurs in the lower back (lumbar spine) where a vertebra slips out of place onto the bone below it. In most cases, spondylolisthesis occurs when bones, joints and ligaments in the spine age and weaken. As they weaken, they may not be able to hold the spinal column in alignment.
Spondylolisthesis is a common cause of back pain in adolescents. Many teens experience symptoms during a growth spurt during puberty. If left untreated, spondylolisthesis can lead to long-term chronic low back pain or spinal deformity.
Types of spondylolisthesis
There are three main types of spondylolisthesis:
- Congenital spondylolisthesis — occurs when the bones do not form correctly during fetal development.
- Isthmic spondylolisthesis — bones are weakened from stress fractures in the lumbar spine.
- Degenerative spondylolisthesis — as the joints age, they become dehydrated and are unable to resist movement by the vertebrae. This is the most common type of spondylolisthesis and occurs in people over 40.
Causes of lumbar spondylolisthesis
Spondylolisthesis can be caused by a variety of problems to the joints in the lumbar spine such as:
- Trauma to a joint, ligaments or bones
- Joint damage caused by arthritis or an infection
- Stress fracture from overuse of a joint
- Birth defects
Risk factors for spondylolisthesis
Factors that increase your likelihood of developing spondylolisthesis are directly correlated to the cause of the condition. Risk factors include:
- Genetics — if you have a family history of back or spinal issues, you are more likely to develop spondylolisthesis
- Sports — any activity or sport that hyperextends the lower back such as gymnastics, dance or ice skating
- Trauma to the lower back — repeated trauma to the lower back (such as getting hit in the back during football) can increase chances of developing spondylolisthesis
Symptoms of spondylolisthesis
Some patients with mild lumbar spondylolisthesis do not experience symptoms and may not know they have a problem. If you are experiencing symptoms of spondylolisthesis, the most common symptom is low back pain that feels like a muscle strain.
Other symptoms of spondylolisthesis may include:
- Buttocks pain
- Leg pain
- Tight hamstrings
- Numbness in the legs
- Tingling in the legs
- Loss of bladder control (rare)
Diagnosis for lumbar spondylolisthesis
Spondylolisthesis is diagnosed through diagnostic imaging tests. Your doctor will order an x-ray if they suspect you have the condition during a physical exam. X-ray images can reveal if a vertebra has slipped forward compared to the adjacent vertebrae.
There are five grades of spondylolisthesis that can be diagnosed:
- Grade I — slip of less than 25 percent
- Grade II — slip of between 25 and 50 percent
- Grade III — slip of between 51 and 75 percent
- Grade IV — slip of between 75 and 99 percent
- Grade V — complete slippage
Other diagnostic tests to confirm spondylolisthesis or rule out other spinal conditions include:
- MRI (magnetic resonance imaging) or CT (computed tomography) scan — an MRI or CT scan can also help evaluate the severity of your condition
- PET (positive emission tomography) scan — in rare cases, your doctor may order a PET scan to determine if bone has been affected by the spondylolisthesis
Treatment for lumbar spondylolisthesis
Although most patients with spondylolisthesis can be treated with conservative treatments, patients who are not responding to nonsurgical treatments may be candidates for surgery.
Nonsurgical treatment options for spondylolisthesis include:
- Limiting activity — it is important to avoid activities that cause vertebrae damage until the area heals, including sports.
- Medications — nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen are helpful to relieve pain associated with spondylolisthesis.
- Physical therapy — physical therapy exercises and stretches can help strengthen the core, stretch the hamstrings and increase range of motion in the lumbar spine
- Cortisone epidural injection — an epidural injection can help relieve symptoms such as tingling, numbness and pain in the lumbar spine.
- Brace — a brace can help bring the affected vertebrae closer together to promote healing.
When nonsurgical treatments are not effective, your bones are continuing to move, and your pain is severe, surgery may help relieve your symptoms.
Surgical treatment options for spondylolisthesis include:
- Decompression surgery — the goal of decompression surgery is to relieve pressure on the spinal cord or nerves to relieve your symptoms.
- Spinal fusion — the goal of spinal fusion is to fuse the bones of the spine together, so they can’t move.
- Decompression surgery — decompression alleviates symptoms by removing affected vertebra, sometimes performed with spinal fusion.
After surgery, your doctor will likely recommend a back brace until the area heals and physical therapy to strengthen the muscles in the affected area.