What is Spondylolisthesis?
Spondylolisthesis is a spinal condition that effects approximately 6 percent of Americans, where a vertebrae slips forward or backward onto the disc below it. Although spondylolisthesis is usually found in the lower back, it can also happen to vertebrae in the upper and middle back. This condition is commonly known as a “slipped disc” that can place pressure on the vertebrae below and spinal nerve roots causing immense pain and discomfort. Although this condition has a variety of types and grades, most cases have common symptoms and can be alleviated with a conservative treatment plan.
Types and Grades of Spondylolisthesis
While there are five different types of spondylolisthesis, some are more common than others.
- Isthmic. This type of spondylolisthesis is brought on when fractures in a vertebrae, or spondylosis, cause the vertebra to slip out of place. This type is most commonly found in those who experience repeated trauma or athletes that experience hyper-extension movements in sports like gymnastics and football.
- Degenerative. As the body ages, the cartilage between discs, joints and ligaments in the spine begin to deteriorate which can lead to various spine conditions. A combination of disc degeneration, arthritis, and looseness of ligaments can make the spine unstable and cause degenerative spondylolisthesis. Along with isthmic, this is one of the most common forms of spondylolisthesis.
- Congenital. Congenital spondylolisthesis is a spinal condition that is present at birth when the bones are formed abnormally. For those born with an irregular spine arrangement, there is an increased risk of a vertebra slipping.
The other types of spondylolisthesis that are less common:
- Traumatic. This condition develops after a spinal injury or fracture that causes a vertebra to move out of place.
- Pathological. This type of spondylolisthesis occurs when the spinal cord is damaged from another illness or disease. Most common precursors for this type include a tumor, infection, or osteoporosis.
- Post-surgical. In rare cases, this condition can become worse after a spinal surgical procedure and can cause post-surgical spondylolisthesis.
There are four grades of slippage used when diagnosing a patient with spondylolisthesis. About 90 percent of spondylolisthesis cases are either a grade 1, when the vertebra slips by 1-25 percent of the width of the vertebral body on to another, or grade 2 when the vertebra slips by 26-50 percent. These grades can be treated by conservative treatment options and typically do not require surgery. Grade 3 (51-75 percent) and grade 4 (76-100 percent) may require surgery if the patient experiences constant pain from the slippage.
What Causes Spondylolithesis
Several different factors can contribute to the actual cause of spondylolisthesis. Age, sex, heredity and active lifestyle can all contribute to this condition. For degenerative spondylolisthesis, very few men and women experienced this condition before the age of 50. After age 50, the chances for degenerative spondylolisthesis increase in both sexes as they get older, however women are three times more likely to be affected and experience faster development of the condition. Cases of spondylolisthesis found in children are usually congenital, or caused from a birth defect, while isthmic spondylolisthesis is more likely to be found in teenagers. As they continue to grow, fractures in the vertebra can cause spondylolisthesis in this demographic, especially teenagers that are involved in sports.
Symptoms and causes of spondylolisthesis varies by case. Those with the condition can have a range of symptoms while others experience no symptoms at all. However, one of the most common symptoms for spondylolisthesis is lower back pain that feels like a muscle strain.
Other symptoms include muscle spasms and tightness in the hamstrings. This effect on the hamstrings can cause short, waddle-like strides when walking and can decrease your range of motion. If the slipped vertebra is putting pressure on a nerve in the spine, symptoms like pain, numbness or tingling throughout the legs and feet can also be common. This nerve irritation that, often referred to as sciatica, can also be a symptom of spondyloltisthesis.
In addition to sciatica, patients can experience other spine conditions like spinal stenosis as a symptom. Spinal stenosis is narrowing in the spinal column around the spinal cord or its nerve roots. This can cause immense pain from the pressure on the spinal cord and nerves.
When diagnosing spondylolisthesis, doctors often use X-rays and MRI scans to determine the type and grade of the slipped vertebra, before starting a treatment plan. For determining which disc has slipped as well as the grade, a side or lateral X-ray of the lower back is taken. A magnetic resonance imaging, or MRI scan shows a more detailed image of the bone and nerves surrounding the slipped disc.
Spondylolisthesis Treatment Options
Once the degree of slippage is determined, a treatment and management plan can be put in place by your doctor. Depending on the symptoms and overall health of the patient, most cases are managed or treated with conservative treatment options.
Typical spondylolisthesis therapies include:
- Physical Therapy. Aimed to strengthen the lumbar and hamstring muscles and support the core, physical therapy can increase flexibility and alleviate symptoms of spondylolisthesis over time.
- Anti Inflammatory Medicines. Medications like ibuprofen can be used for pain management and to decrease muscle and nerve inflammation.
- Hyperextension Brace. For isthmic spondylolisthesis cases, a hyperextension brace may be used to bring the discs closer together in order to properly heal.
- Epidural Injections. The corticosteroid medicine used in epidural injections ease pressure and inflammation in the nerve roots surrounding the slipped disc in the spine.
- Exercise. For grade 1 spondylolisthesis, home exercises can decrease back pain symptoms and help improve this spine condition.
- Other. Rest and limited lifting or hot and cold treatments.
- Surgery. If conservative treatments fail to work, surgery also may be an option to physically move or fuse the slipped disc in order to maintain a normal spine shape. Depending on the type of spondylolisthesis and grade, surgery can help the patient restore mobility and motion in the back once the nerve and vertebra are stabilized usually through some form of spinal fusion.
Some complications patients experience from spondylolisthesis include chronic back pain, reduced movement and mobility, as well as numbness and tingling in the lower back and legs. Patients with these severe symptoms often undergo surgery in order to relieve the pressure and pain on surrounding discs and nerves in the spine.
While spondylolisthesis is not preventable, those with the condition have a positive outlook for the future. If the condition is detected before the slippage reaches a grade 3 or 4, a conservative treatment plan can alleviate most symptoms. Even for more severe cases of spondylolithesis, surgery usually corrects the slipped disc relieves symptoms.
If you are in need of some extra support or guidance, our Back Wellness Coaches are always available to help you along your journey. With our team of doctors, surgeons, chiropractors, massage therapists, and physical therapists we can beat back pain.