SPONDYLOLISTHESIS

What is a Spondylolisthesis?

The medical term “Spondylolisthesis” refers to a spinal condition that affects the lower vertebrae and causes lower back pain (Ebraheim, Elgafy, Gagnet, Andrews, & Kern, 2018). The word spondylolisthesis comes from Greek “spondylos”, which means spine, and “listhesis” which means sliding movement. Spondylolisthesis involves spinal instability where any of the lower vertebrae displaces more than they should. The grading of spondylolisthesis depends upon the degree of slippage of one vertebral body relative to the subsequent adjacent vertebral body. This ultimately creates pressure on the nerve and results in severe lower back and leg pain. This displacement can occur in any direction.

Anterolisthesis refers to the forward or anterior displacement of the lower vertebrae. This mostly involves the 5th lumbar vertebrae. Also, retrolisthesis refers to the posterior or backward displacement of one vertebrae in context to another. Additionally, the lateral listhesis or latero-listhesis includes the displacement in the lateral direction. Patients with any displacement mostly recover by using nonsurgical treatment. Severe Spondylolisthesis may require surgery.

Types of Spondylolisthesis

The classification of spondylolisthesis includes the following (Shyam, Hadgaonkar, Group, & Sancheti, 2019):

  • Degenerative: most often appears in older adults where spondylolisthesis develops due to facet arthritis, ligamentum flavum weakness, slippage of vertebrae, etc.
  • Traumatic: results from acute fractures in the neural arch.
  • Dysplastic: caused by congenital abnormalities of the upper sacral facets of the 5th lumbar vertebrae.
  • Isthmic: Involves a defect in the pars inter-articularis.
  • Pathologic: Caused by infection or a malignancy.
  • Post-surgical: Caused by complications after surgery.

According to the degree of the slippage, the classification may include the following:

  • Grade I spondylolisthesis: 0–25%
  • Grade II spondylolisthesis: 25- 50%
  • Grade III spondylolisthesis: 50–75%
  • Grade IV spondylolisthesis: 75–100%
  • Grade V spondylolisthesis: greater than 100%

This measures the percentage of the width of the vertebral body. Research estimates grade I accounts for almost 75% of spondylolisthesis cases.

What Are The Common Symptoms and Causes of Spondylolisthesis?

The symptoms of spondylolisthesis may vary according to the degree of severity. Patients with mild cases produce no or mild symptoms. The most common symptoms may include (Aoki et al., 2020):

  • Severe lower back pain
  • General stiffness of the back and a tightening of the muscles of hamstrings and buttock
  • Tenderness of the lower back
  • Pain in the thigh
  • Difficulty walking or standing for a long period
  • Numbness, weakness, or tingling in the foot
  • Protruding abdomen
  • Waddling movements during walking

Spondylolisthesis occurs due to several main causes. Causes of spondylolisthesis depend upon age, heredity, and lifestyle factors. Children may suffer from spondylolisthesis as the result of a birth defect or injury. Besides this, hereditary plays a great role in developing this condition. Rapid growth during adolescence can also contribute to developing this disease. Several sports like football, gymnastics, weightlifting, track, and field may cause strain and overstretch the lower back. Spondylolysis also acts as a precursor to spondylolisthesis. Spondylolysis differs from the spondylolisthesis and occurs due to the fracture in a vertebra.

How Do Spinal Specialists Diagnose Spondylolisthesis?

Spondylolisthesis occurs in about 4% to 6% of the adult population. People can live with this condition for many years receiving no treatment unless they show some major signs and symptoms. Degenerative spondylolisthesis frequents in people older than 50 and found more prominently in women than men.

Initially, spinal specialists diagnose spondylolisthesis by conducting a physical examination of the patient. Patients with spondylolisthesis show difficulty in raising their legs straight outward during simple exercises. Other imaging test procedures may include (Aldawsari, Alotaibi, & Alsaleh, 2020):

  • Plain Radiography (X-Ray)
  • Magnetic Resonance Imaging (MRI)
  • Computed Tomography (CT)

Physicians also perform palpation and maneuver techniques that include motion testing, lumbar hyperextension, straight leg raise, etc. to detect this condition.

How Do Neurosurgeons Treat a Spondylolisthesis?

Treatment of spondylolisthesis depends upon the severity of pain and slippage of the vertebra. Common nonsurgical treatment methods include (Omidi-Kashani, Ebrahimzadeh, & Salari, 2014):

  • Complete rest: This includes a break from strenuous activities and sports.
  • Physical therapy: This evaluates the postural and compensatory movement abnormalities. This therapy includes spinal flexion and extension exercises with a focus on core stabilization and muscle strengthening.
  • Bracing: This helps to stabilize the spine. This limits movement of the vertebrae and allows the fractures to heal in young.
  • Medication: This includes nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen or naproxen to relieve pain. Using epidural steroid injections benefits patients with this condition.

The American Academy of Orthopaedic Surgeons recommends trying conservative treatments first. Finally, the neurosurgeon recommends surgery if the above treatments fail. Adults suffering from severe cases of spondylolisthesis require spinal fusion. This includes the surgical correction of the misplaced vertebra that slipped so far down. Neurosurgeons help to stabilize the spine by using a bone graft and metal rods. The whole process takes four to eight months to fully fuse. In case of any complications, contact our physician immediately at the hospital.

If You Think You May Be Suffering From Spondylolisthesis and require a Fort Worth Brain and Spine Specialist, Contact Longhorn Brain & Spine Immediately To Get a Consultation.

References

Aldawsari, K., Alotaibi, M. T., & Alsaleh, K. (2020). Top 100 Cited Articles on Lumbar Spondylolisthesis: A Bibliographic Analysis. Global Spine Journal, 10(3), 353–360. https://doi.org/10.1177/2192568219868194

Aoki, Y., Takahashi, H., Nakajima, A., Kubota, G., Watanabe, A., Nakajima, T., … Ohtori, S. (2020). Prevalence of lumbar spondylolysis and spondylolisthesis in patients with degenerative spinal disease. Scientific Reports, 10(1), 1–4. https://doi.org/10.1038/s41598-020-63784-0

Ebraheim, N., Elgafy, H., Gagnet, P., Andrews, K., & Kern, K. (2018). Spondylolysis and spondylolisthesis: A review of the literature. Journal of Orthopaedics, 15(2), 404–407. https://doi.org/10.1016/j.jor.2018.03.008

Omidi-Kashani, F., Ebrahimzadeh, M. H., & Salari, S. (2014). Lumbar spondylolysis and spondylolytic spondylolisthesis: Who should be have surgery? An algorithmic approach. Asian Spine Journal, 8(6), 856–863. https://doi.org/10.4184/asj.2014.8.6.856

Shyam, A. K., Hadgaonkar, S., Group, S., & Sancheti, P. (2019). A review article on recent trends in surgical treatment of spondylolisthesis. (August). https://doi.org/10.13107/JOR.2019.V05I01.004