Spondylolisthesis

Learning the basics about how your spine works can help you better understand the problems that can cause back pain. The spine protects the spinal cord and holds up the head, shoulders and upper body. It provides support to help you stand up straight and bend and twist flexibly.

The spine is comprised of three segments: the cervical spine in the neck, the lumbar spine in the lower back and the thoracic spine in the chest. The curves in these segments help balance and allow a person to stand upright. Deformities in any of these curves can cause poor posture.

The parts of the spine are:

• Vertebrae – the small bones stacked on top of one another create the natural curves of the back. The vertebrae form a canal that protects the spinal cord and nerve roots.
• Spinal cord and nerves – the spinal cord serves as a pathway between the brain and the rest of the body. It extends from the skull to your lower back and travels through the middle of each stacked vertebrae, called the central canal. The spinal cord sends motor commands through the nerves between the brain and muscles.
• Muscles and ligaments – provide support and stability to the spine and upper body.
• Intervertebral disks – flat and round disks located in between the vertebrae that act as shock absorbers for the spine.
• Facet joints – the small joints between the back of the vertebrae that allow the spine to move and rotate.

What Is Spondylolisthesis?

Spondylolisthesis is a common cause of lower back pain in children and adolescents. This condition occurs when a stress fracture occurs in one vertebra. Spondylolisthesis is common among people who engage in sports that involve repeated stress on the lower back, such as gymnastics, football and weightlifting.

In spondylolisthesis, the stress fracture weakens the bones so much that they cannot maintain their proper position in the spine, causing the vertebrae to slip forward directly to the bone below it. The instability in the spine can cause pain and may also promote the formation of bone spurs or arthritis.

What Causes Spondylolisthesis?

This condition most often occurs in children and adolescents during rapid growth. Other causes of spondylolisthesis include:

• Overuse - In addition to the adolescent growth spurt, this condition can affect young people who participate in sports that require overstretching of the lumbar spine. The repetitive activity in these sports can weaken the pars interarticularis, a small, thin portion of the vertebrae that connects the upper and lower facet joints leading to fracture or slippage of a vertebra.
• Degenerative Spondylolisthesis - Advanced age and general wear and tear cause changes in the spine. As the intervertebral disks in the spine weaken, the ligaments and joints that hold the vertebrae in their proper place also weaken, resulting in degenerative spondylolisthesis in some people.
  
  The narrowing and buckling of the spinal canal can eventually lead to spinal cord compression or spinal stenosis, a common problem among people with degenerative spondylolisthesis. The condition mainly affects people over 50 years old. It is more common in women than in men.
• Spondylolytic Spondylolisthesis (Isthmic Spondylolisthesis) - A crack or stress fracture in the vertebrae occurs during adolescence and goes unnoticed until adulthood. People with isthmic spondylolisthesis often suffer spinal stenosis, just as in degenerative spondylolisthesis, causing bone spurs to narrow the spinal canal and result in nerve compression.
• Genetics - Some people may be born with thinner vertebral bone than normal, putting them at risk of fractures.

What Are the Symptoms of Spondylolisthesis?

In many cases, people with spondylolisthesis do not learn of their condition until they undergo an X-ray exam for an unrelated injury or symptom. Children may not exhibit any symptoms until they are 18 years old. When symptoms occur, they may vary from mild to severe. The most common spondylolisthesis symptom is lower back pain. Other spondylolisthesis symptoms may include:

• Leg or lower back pain, including weakness associated with prolonged standing or walking.
• Lower back pain that radiates to the buttocks and back of the thighs.
• Back stiffness.
• Tight hamstrings (the muscles in the back of the thigh).
• Difficulty standing and walking.
• Tenderness in the area of the vertebrae that are out of place.

Patients with severe spondylolisthesis or high-grade slips may experience increased and abnormal lordosis (also called swayback). In later stages, it may develop kyphosis (roundback) as the upper spine falls off the lower spine.

How To Diagnose Spondylolisthesis?

• Medical History and Physical Examination - If you have symptoms of spondylolisthesis, your doctor may ask about your medical history and perform a physical examination of different areas of your back. You may be asked to do certain movements, including bending forward, backward and side-to-side, to look for areas of tenderness, limited range of motion, muscle spasms and muscle weakness.
• Imaging Tests - Your doctor may request additional imaging tests to help confirm the diagnosis of spondylolisthesis. Diagnostic tests may include the following:
• X-rays.
• Computed tomography (CT) scans.
• Single photo emission computed tomography (SPECT) scans.
• Magnetic resonance imaging (MRI) scans.

How To Treat Spondylolisthesis?

Spondylolisthesis treatments aim to reduce pain, allow a recent pars fracture to heal, and return the patient to sports and other daily activities. Although conservative treatments will not repair vertebral slippage, they are usually enough to treat the symptoms and help relieve pain.

Spondylolisthesis Treatment Without Surgery

Your doctor may recommend the following nonsurgical spondylolisthesis treatments:

• Rest. Avoid sports and other activities that cause excessive stress on the lower back to help improve back pain and other symptoms.
• Physical therapy and exercise. Engage in specific activities that can strengthen your lower back and abdominal muscles and improve the flexibility of your tight hamstrings.
• Medication. Take analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen, to help relieve pain.
• Steroid injections. Decrease pain and swelling through cortisone injected around the nerves or in the outermost part of the spinal canal.
• Bracing. Wear a back brace for some time to limit movement in the spine. However, bracing is not recommended for patients with longer-term pain due to their low chance of healing, even after several months in a brace.

Surgical Treatment

Spinal fusion is an option if noninvasive treatments fail to treat symptoms due to severe or high-grade slippage, progressively worsening slippage and chronic back pain that does not go away even after nonsurgical treatment.

The goals of spinal fusion are to prevent further slip progression, stabilize the spine and alleviate significant back pain by fusing the affected vertebrae so that they heal into a single, solid bone.

Recommendations

Patients with degenerative spondylolisthesis and isthmic spondylolisthesis can benefit from nonsurgical treatment. When spondylolisthesis surgery is required, patients with spondylolisthesis experience improved symptoms, sometimes within a few weeks or several months after the procedure.

If you have had surgery to treat spondylolisthesis, your doctor may recommend specific stretching exercises to strengthen your back and abdominal muscles to help prevent future injury. Make sure to schedule regular check-ups to prevent problems from developing post-surgery.