What is Spondylolisthesis?
Spondylolisthesis is a kind of spine instability in which one vertebra slips forward over the one below it that causes lower back pain. This can occur in any region of the spine, but is most commonly seen in the lower back (lumbar spine). Lumbar Spondylolisthesis is the most common type of spondylolisthesis, and it occurs in the lower back. It can cause lower back pain, as well as pain or weakness in the legs. It is often caused by degenerative changes in the spine, such as arthritis or disc degeneration. Cervical Spondylolisthesis is a specific type of spondylolisthesis that affects the cervical spine, or the neck region of the spine. It occurs when one vertebra in the neck slips forward over the one below it, causing neck pain and potentially other symptoms such as numbness, tingling, or weakness in the arms or hands.
Spondylosis vs Spondylolisthesis: what’s the difference?
Spondylosis refers to a general degeneration of the spine, including the vertebrae, discs, and joints. It is a broad term that can encompass various spinal conditions, including spondylolisthesis. Spondylolisthesis, on the other hand, specifically refers to a condition in which one vertebra slips forward over the one below it. While spondylosis can be a contributing factor to spondylolisthesis, they are not synonymous terms and have different implications for treatment and management.
How can one determine the severity of spondylolisthesis?
Spondylolisthesis is graded based on the severity of the slippage of the affected vertebra. Low-grade spondylolisthesis refers to a slippage of less than 50% of the affected vertebra, while high-grade spondylolisthesis refers to a slippage of more than 50%. The grade of spondylolisthesis can help determine the appropriate treatment plan for each individual case. High-grade spondylolisthesis may require more aggressive treatment, such as surgery, while low-grade spondylolisthesis may be managed with conservative measures.
High Grade Spondylolisthesis – Young Girl Narrates her success story
Types of Spondylolisthesis
There are five types of spondylolisthesis:
- Congenital spondylolisthesis: This type of spondylolisthesis is present at birth and is caused by a defect in the development of the vertebrae.
- Isthmic spondylolisthesis: This type of spondylolisthesis is caused by a fracture or defect in the pars interarticularis. It can be caused by repetitive stress, such as in athletes who perform repetitive hyperextension of the lower back.
- Degenerative spondylolisthesis: This type of spondylolisthesis occurs as a result of degenerative changes in the spine, such as osteoarthritis or disc deg
- Traumatic spondylolisthesis: This type of spondylolisthesis is caused by a traumatic injury to the spine, such as a car accident or fall.
- Pathological spondylolisthesis: This type of spondylolisthesis is caused by a disease or condition that weakens the bones, such as osteoporosis or a tumor.
Symptoms of Spondylolisthesis
The symptoms of spondylolisthesis can vary depending on the severity and location of the condition. However, common symptoms may include:
- Lower back pain,
- Muscle spasms,
- Stiffness in the lower back, and
- Difficulty standing or walking for extended periods.
- Nerve compression. In more severe cases, there may also be nerve compression resulting in numbness, tingling, or weakness in the legs or arms.
Causes of Spondylolisthesis
Spondylolisthesis can be caused by a variety of factors, including:
- Birth defects of the spinal column. It occurs when a baby’s spine doesn’t form the way it should before birth. The misaligned vertebrae put the person at risk for slippage later in life.It happens when a baby’s spine fails to develop properly during pregnancy, which can lead to an increased risk of slippage later on.
- Repetitive stress or overuse of the spine such as in athletes. Participation in sports that involve repetitive hyperextension of the lower back, such as gymnastics, football, or weightlifting.
- Degenerative changes in the spine, such as arthritis or disc degeneration
- Traumatic injuries to the spine
- Diseases or conditions that weaken the bones.
It is important to identify the underlying cause of spondylolisthesis in order to determine the best course of treatment and management for each individual case. In some cases, conservative measures such as physical therapy and pain management may be sufficient, while others may require surgical intervention.
Diagnosis and Treatment Options
A proper diagnosis of spondylolisthesis involves a thorough physical examination, medical history review, and imaging tests such as X-rays or MRI scans.
CT scan, according to Dr Rajesh Verma, is a better investigation option allowing for a clearer visualization of the degree of slippage, associated conditions, and potential impacts on surrounding structures. Once a diagnosis is confirmed, treatment options will depend on the severity of symptoms and underlying cause.
At what point should I seek medical attention?
If you are experiencing persistent lower back pain, stiffness, or difficulty standing or walking, it is important to see a doctor for an evaluation. If you have a family history of spondylolisthesis or have participated in activities that put repetitive stress on your spine, you may be at a higher risk for developing the condition. It is important to seek medical attention and consult the spine specialist. Early diagnosis and treatment can help prevent further progression of spondylolisthesis.
Exercise for spondylolisthesis
- Pelvic tilt: Lie on your back with your knees bent and feet flat on the floor. Tighten your abdominal muscles and press your lower back into the floor. Hold for a few seconds and then release. Repeat 10 times.
- Cat-cow stretch: Start on your hands and knees, with your hands under your shoulders and knees under your hips. Inhale and arch your back, bringing your head up and looking towards the ceiling. Exhale and round your back, tucking your chin to your chest. Repeat 10 times.
- Bridging: Lie on your back with your knees bent and feet flat on the floor. Lift your hips off the floor, keeping your shoulders and feet on the ground. Hold for a few seconds and then lower your hips back down. Repeat 10 times.
- Seated twist: Sit on the edge of a chair with your feet flat on the floor. Place one hand on the opposite knee and twist your torso towards that side. Hold for a few seconds and then switch sides. Repeat 10 times on each side.
Exercises to Avoid with Spondylolisthesis
It is also important to avoid exercises that cause pain or discomfort. Some exercises to avoid in spondylolisthesis include:
- Push-up while lying on the stomach
- Standing extensions
- Lifting legs while lying on the stomach
- Back extension machine at the gym
- Running, jumping, or contact sports
Conservative treatments of Spondylolisthesis
- Rest and activity modification: Avoiding activities that aggravate symptoms can help to reduce pain and promote healing.
- Physical therapy: Specific exercises can help to strengthen the muscles supporting the spine and improve flexibility.
- Pain management: Over-the-counter or prescription pain medication may be recommended to manage symptoms.
- Bracing: A back brace may be prescribed to support the spine and reduce pain.
- Injections: Corticosteroid injections may be used to reduce inflammation and pain in the affected area.
Surgical Treatments:
- Spinal fusion: This surgery involves joining two or more vertebrae together to stabilize the spine and reduce pain.
- Decompression surgery: If there is nerve compression causing symptoms, a decompression surgery may be performed to relieve pressure
- Laminectomy: This procedure involves removing a portion of the vertebra to relieve pressure on the spinal cord or nerves.
- Foraminotomy: This surgery involves enlarging the space where nerve roots exit the spine to relieve pressure.
- Artificial disc replacement: In some cases, an artificial disc may be used to replace a damaged disc and maintain motion in the spine.
- Dynamic stabilization: This procedure involves using rods, screws, or other devices to stabilize the spine while preserving some movement.
- Osteotomy: In severe cases, where there is significant spinal deformity, osteotomy may be performed to realign the spine.
