Degenerative spondylolisthesis occurs from long-standing instability of the spine. Patients with this condition often have severe back pain and radiculopathy. While quite common, many people do not even know they have this condition.
What causes spondylolisthesis?
The cause of degenerative spondylolisthesis is multifactorial, with many interlinked pathologies. Conditions that contribute to spondylolisthesis include facet joint arthritis, degenerative disc disease, and spinal stenosis. Arthritis of the facet joints cause loss of normal spine structural support. In addition, there is malfunction of ligament stabilization and ineffective muscle stabilization. Degenerative disc disease also leads to spinal instability and misalignment of the vertebrae.
Who is affected by degenerative spondylolisthesis?
Spondylolisthesis occurs most often at the lower lumbar spine. It affects females more than males, those age 50 years and older, and persons with a history of spinal arthritis. In a report from the Framingham Heart Study, researchers evaluated CT scans of patients with back pain. They found that the female-to-male ratio of degenerative spondylolisthesis was 3:1, and the prevalence of this condition increased from the fifth through eighth decades of life. Based on this clinical study, the rate of lumbar spondylolysis was 11.5% in the general population, and spondylolisthesis was seen in 20% or the study participants.
What are the symptoms of degenerative spondylolisthesis?
Symptoms of spondylolisthesis include back pain, radiating pain down an arm or leg, numbness/weakness of an arm or leg, and pain that gradually worsens over the day. Many patients report leg pain that shifts from side-to-side, as well as cold feet, altered gait, and unexpected falls with walking.
How is degenerative spondylolisthesis diagnosed?
The doctor will use advanced imaging studies to evaluate for spondylolisthesis. A magnetic resonance imaging (MRI) scan uses powerful magnets and computer technology to produce 3-D images of the spine and associated support structures. The doctor may also order a computed tomography (CT) scan, contrast-enhanced CT, and/or myelography to evaluate for spondylolisthesis. Grading of spondylolisthesis involves the Meyerding scale where the diameter of the lower vertebral body is divided and grades are assigned to slips of one, two, three, or four quarters of the vertebra.
What are the treatment options for spondylolisthesis?
To treat the symptoms of spondylolisthesis, the orthopedic specialist may use a combination of measures. These include:
- Medications – The initial course of treatment involves use of analgesics and anti-inflammatory medications. For patients with persistent pain, opioids and muscle relaxants are used.
- Physical therapy – To promote spine flexion and deconstruction of the thecal sac, exercises in physical therapy help. These include swimming, walking, and stationary bicycling. Measures used for pain relief include ultrasound, bracing, and electrical stimulation. In a recent study, 62% of physical therapy patients had improvement at the 3-year follow-up.
- Epidural steroid injection (ESI) – In a recent study, researchers suggested that when patients fail on 4-6 weeks of physical therapy, they could benefit from a series of ESIs. This involves delivery of a steroidal preparation around the thecal sac and nerve roots to relieve pain and associated symptoms. Researchers found that more than half of patients treated with ESI had functional improvement 2 years after injections.
Will I need surgery?
Regarding spondylolisthesis, surgery is a consideration when the disorder causes neurologic deficit or when the slip progresses. Spinal fusion and instrumentation help stabilize the spinal column. This procedure involves use of a bone from the patient’s pelvis or donor bone from a cadaver. In addition, medically designed implants (rods, screws, and cages) are used to hold vertebral segments in place.
Kalichman L & Hunter DJ (2008). Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J, 17(3), 327-335.
Kalichman L, Kim DH, Li L, et al. (2009). Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine, 34(2), 199-205.