Spondylolisthesis

The Problem

Spondylolisthesis literally means slippage of the vertebrae.  The video points out two of the most common causes of this problem, degenerative and isthmic.  This process usually involves the lower segments of the lumbar spine.

In degenerative spondylolisthesis, degenerative changes involving the facet joints and loosening of spinal ligaments can produce excess motion that permits one vertebra to slip forward on the one adjacent to it.  In isthmic spondylolisthesis, the excess motion and slippage are the result of fractures (called spondylolysis) on both sides of a given vertebra in an area known as the pars interarticularis. Spondylolisthesis is two to four times more common in males, compared to females.

Although spondylolysis or spondylolisthesis can produce low back pain, the presence of either in a patient does not always explain why they may have low back pain. Spondylolysis is unlikely to be the cause of low back pain in patients older than 40 years, but is more likely to be the cause of pain in someone under 25.  Both spondyloysis and spondylolisthesis can occur without symptoms.  At times, the vertebral slippage can lead to pinching of nerve structures in the central canal or nerve root canals.

Diagnosis

X-rays can show the pars fractures or the slippage of one vertebra on another.   Special radioisotope studies are sometimes used, especially in younger patients, when a pars fracture is suspected, but is not seen on x-rays.  Bending views of the spine are used to show whether there is instability in the spine with motion. Symptoms of numbness, tingling, weakness or radiating pain are evaluated with MRI, CT scan or electrodiagnostic testing.

Treatment

Once spondylolisthesis has been identified as the source of a patient’s low back pain, treatment is determined by the extent of the slippage and the presence or absence of instability with motion.  When the slippage is stable, pain can be managed through a combination of pain and anti-inflammatory medications and a back flexion exercise program.  This helps to reduce excess low back curvature by stretching tight low back and leg muscles and works to strengthen the core muscles to stabilize the spine.

Lumbar epidural steroid injections can be effective in treating the nerve root irritation that can be present following vertebral slippage, assuming that the slippage is stable.  Surgery may be required in younger patients or those involved in heavy physical labor when slippage is severe and is accompanied by neurological symptoms or deficits in strength or sensation.