Spondylolisthesis simply refers to one vertebra that has slipped forward in relationship to the vertebra immediately below it. There are several causes for this condition, most common of which are spondylolysis and degenerative disc disease. Spondylolysis refers to a small fracture in one of the vertebrae in your spine that usually happens at a young age and may progress with time. This fracture leads to loss of normal alignment between two vertebrae, resulting in spondylolisthesis. Degenerative disc disease occurs as the discs that sit between vertebral bodies lose their elasticity and water content with aging, which leads to increased stress on the joints in the spine. Overgrowth of these joints pushes one vertebra forward in relation to the vertebra below, resulting in spondylolisthesis.
What are the Symptoms of Spondylolisthesis?
Symptoms of spondylolisthesis may include low back pain and buttock pain, as well as pain, numbness, tingling, or weakness in the legs. These symptoms are usually aggravated by prolonged standing or walking and relieved with rest.
How is Spondylolisthesis Diagnosed?
In addition to performing a history and physical exam, your physician will typically order imaging to confirm the diagnosis. This usually involves x-rays of your lower back that may illustrate a fracture or slippage of your vertebra. In addition, a computed tomography (CT) and/or magnetic resonance imaging (MRI) scan are typically obtained to better determine the degree of slippage between the bones and compression of nerves in your spine.
How is Spondylolisthesis Treated?
Depending on the severity of your symptoms, a course of non-surgical treatment may be prescribed by your primary care physician or neurosurgeon. This typically involves a combination of medications, physical therapy, and epidural steroid injections.
Medications that are typically prescribed include pain medications to help with your symptoms as well as anti-inflammatory medications, such as ibuprofen, to help decrease inflammation around the nerves in your spine. Occasionally other medications such as Lyrica and Neurontin are prescribed to help with nerve pain.
In addition to medications, a physical therapy program may be incorporated as a form of non-surgical treatment. A physical therapy program usually begins with stretching exercises to restore flexibility to tight muscles in the neck, trunk, arms, and legs. Depending on your response to physical therapy, stretching exercises may progress to cardiovascular exercise and strengthening exercises for your arms, legs, and trunk muscles.
Epidural steroid injections may also be prescribed and involve injection of corticosteroids into the area around your spinal cord and nerves in order to reduce inflammation.
If you fail to respond to non-surgical treatment, surgery may be recommended. This typically involves a fusion procedure, with placement of small screws and rods to hold the spine together and to prevent any further progression of the slippage between the vertebrae. A bone graft is typically placed between the vertebra to aid with healing and fusion. A laminectomy procedure may also be performed at the same time in order to create more room for the spinal nerves by shaving overgrown bone and ligaments.
Where Can I Find More Information?
North American Spine Society. (2009). Adult Isthmic Spondylolisthesis.
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