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Spondylolisthesis

Let’s begin with the most obvious question about spondylolisthesis. How do you pronounce it?? It’s like this: spahn-dih-loe-LISS-thuh-siss. The word comes from the Greek words spondyl, meaning “whorl,” plus olisthesis (dislocation), derived from olisthanein, meaning “to slip, slide, or fall.”

What is spondylolisthesis?

Now that we can pronounce it, let’s get to the real question: What the heck is it? Simply put, spondylolisthesis is the displacement, slippage, or subluxation of a vertebra. Your spinal column is made up of flat, more or less round or ring-shaped bones called vertebrae. They’re stacked up like poker chips and connected to one another by supporting structures, including the intervertebral discs that lie between them.

A misaligned vertebra can compress spinal nerves, causing a kind of pain called radiculopathy, or it can impinge on the spinal cord itself, causing pain and dysfunction known as myelopathy. Spondylolisthesis can occur in the cervical spine, usually at the level of the third and fourth cervical vertebrae or the fourth and fifth cervical vertebrae. Vertebral displacement can also occur in the thoracic spine. But it’s most common in the lumbar spine (the lower back) at the level of the fourth and fifth vertebrae.

Spondylolisthesis is frequently preceded by spondylosis—age-related degeneration of the spine. The term spondylosis is used interchangeably with the term osteoarthritis of the spine.

What are the symptoms of spondylolisthesis?

Spondylolisthesis can cause severe back pain, particularly radiculopathy. Other symptoms are common as well, although not all patients have all symptoms. Your symptoms will depend on the location of the displaced vertebra:

  • Pain radiating down the leg (sciatic pain)
  • Numbness or weakness of an arm or leg
  • Pain that gradually worsens over the course of the day
  • Leg pain that shifts from side to side
  • Cold feet
  • Altered gait (a change in your walking pattern) or pain while walking
  • Diminished coordination and more frequent falls

Patients with cervical spondylolisthesis tend to have focal neck pain that gets worse when the neck is flexed forward or backward. (“Focal” just means that the pain is focused—that is, you can point to the spot where it hurts. The opposite would be a generalized “it hurts all through here” kind of pain.)

Patients with lumbar spondylolisthesis tend to have focal lower-back pain. Sometimes the pain improves when lying down, since that position stabilizes the spine. A displaced lumbar vertebra may also produce sciatic pain in the leg or buttocks, weakness in the legs, or difficulty walking. Walking may intensify the pain.

What causes spondylolisthesis?

There are several forms of spondylolisthesis:

Spondylolisthesis

Blue arrow, Normal pars interarticularis. Red arrow, fractured pars.

Pathologic

Bony, noncancerous tumors can weaken part of the vertebra called the pars interarticularis. The pars is a segment of the ring of bone surrounding the spinal cord.
Weakened bone can fracture (see x-ray image), leaving it untethered and making that segment of the spine unstable.

Dysplastic

Dysplastic spondylolisthesis is a congenital condition in which the facet joints and other structures are slightly malformed.

Isthmic

Isthmic spondylolisthesis usually occurs in children and adolescents as a result of a defect, such as a healed fracture, in the pars. This defect makes the vertebra unstable, and over time it can slip forward.

Degenerative

Spondylolisthesis is often preceded by spondylosis. This condition is characterized degenerative changes that make a portion of the spine unstable:

  • Degeneration of the disc and facet joints
  • Calcification of surrounding ligaments
  • Spinal stenosis (narrowing of the spinal canal)

Degenerative spondylolisthesis is the most common form that we treat at Inspired Spine.

Traumatic

A strong impact can cause traumatic injury to the spine, and vertebrae can be suddenly forced out of alignment, causing spondylolisthesis. Falls and accidents involving motor vehicles often precede traumatic spondylolisthesis, but any serious accident can precipitate such trauma. In one case, a pilot was injured in this way in the ejector seat of a flight simulator.

How is spondylolisthesis treated?

If you have spondylolisthesis but have no symptoms, treatment is unnecessary. If the displacement is causing progressive spinal cord compression, though, you probably do have pain and other symptoms. Unfortunately, myelopathy associated with spondylolisthesis won’t go away on its own. Sooner or later it’ll land you a reservation at the operating table.

Nonsurgical treatments

If your condition is causing pain or dysfunction, such as difficulty walking, treatment is needed. Your doctor will probably try conservative measures first—that is, therapies that don’t require a scalpel or heavy-duty prescription drugs. Cervical collars, traction, physical therapy, and injections are good options for some patients. Many doctors follow a four-pronged approach to initial management of spondylolisthesis:

Antiinflammatory medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Aleve) and ibuprofen (Advil) are great at relieving the pain of spondylolisthesis. Sometimes they’re more effective than muscle relaxants, opioid medications, or short-term oral corticosteroids.

Aerobic fitness

Aerobic physical activity promotes blood flow to areas of nerve compression in the spine and strengthens muscles and other supporting structures. Walking, swimming, and use of an elliptical machine are good aerobic conditioning activities, but use of a stationary bicycle is especially effective for patients with spondylolisthesis.

Look for a bike in which the pedals are more or less below the seat (like on a real bicycle), rather than choosing a recumbent bike, in which the pedals are out in front of you. A more traditional configuration of the seat, pedals, and handlebars shifts your weight toward your upper body, whereas a recumbent bike directs your body weight toward the seat, thereby putting pressure on your lumbar spine.

Weight loss

If you’re overweight or obese, your doctor may recommend that you lose weight. The reason is commonsensical: the less body weight the spine must support, the less it will hurt. That theory, of course, doesn’t always pan out in practice. But if you’re overweight, it’s a gamble worth taking, since weight loss produces a wide range of other health benefits unrelated to the spine.

Management of Osteoporosis

Osteoporosis weakens bones, leading to fractures and other problems. To prevent or slow the progression of spondylolisthesis, your doctor will keep a careful eye on your bone mass to ensure that the bones of your spine are as dense, strong, and healthy as possible.

Surgery

If pain persists despite conservative interventions, you and your physician might decide to proceed with surgery. Surgical correction of spondylolisthesis can improve quality of life dramatically. Traditionally, surgeons have performed an open procedure, which carries significant risks and requires a relatively long recovery period.

Fortunately, for those with lumbar spondylolisthesis, a keyhole spine procedure known as OLLIF helps stabilize the spine, relieve pain, and free impinged nerve roots. Because it requires an incision no wider than an aspirin tablet, keyhole surgery dramatically reduces recovery time and lowers the rate of operative and postoperative complications, such as hemorrhage and infection.

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