Spondylolisthesis

Your spine is made up of a series of bones called vertebrae, which are stacked on top of each other, creating a flexible, supportive column. Between each vertebra are discs that act as cushions, absorbing shock and allowing movement. The spine also has facet joints that help stabilize these vertebrae and enable twisting and flexing. Spondylolisthesis happens when one of the vertebrae in your spine slips out of its normal position, either moving forward or, in some cases, backward.

Disrupting the normal alignment of your spine can cause a range of symptoms, depending on the severity of the slippage. If the vertebra only shifts slightly, you may not notice any signs. However, if the shift is more significant, it can put pressure on the nerves in your spine, potentially causing pain or other symptoms.

What Causes Spondylolisthesis?

Degenerative changes in the spine, particularly in older adults, are the most common cause. Over time, the discs that cushion your vertebrae become less hydrated and thinner. As these discs become thinner, they are more prone to shifting out of place.

Other causes include:

Isthmic spondylolisthesis is caused by a defect or fracture in a part of the vertebra.
Congenital or dysplastic spondylolisthesis which occurs when a person is born with a misaligned vertebra in their spine that predisposes them to slippage.
Traumatic spondylolisthesis, which results from a direct injury to the spine, which forces the vertebrae out of alignment.
Pathologic spondylolisthesis which occurs from an underlying condition, such as a tumor or osteoporosis.
Postsurgical spondylolisthesis, which can develop after spinal surgery if the spine becomes destabilized.

Recognizing the Symptoms of Spondylolisthesis

Many people may not notice any symptoms and may be unaware they have the condition. However, when symptoms do occur, the most common one is lower back pain. This pain can sometimes spread to your buttocks and thighs. Other possible symptoms include:

Muscle spasms in the hamstrings (the muscles at the back of your thighs)
Stiffness in your back
Difficulty walking or standing for extended periods
Pain when bending over
Numbness, weakness, or tingling in your foot

How is Spondylolisthesis Diagnosed?

If your doctor suspects you have spondylolisthesis, they will start with a thorough physical examination to check your range of motion, strength, and reflexes to see if any nerves are affected by vertebral slippage.

To confirm the diagnosis, your doctor may recommend:

A spinal x-ray. This will show if one of your vertebrae has slipped out of place. It can also help determine the severity of the slippage.
A CT scan. It can provide more detailed images of your bones and help identify the exact location and extent of the vertebral slippage.
An MRI. This is beneficial for assessing soft tissues, such as discs, nerves, and the spinal cord, and to determine if the slipped vertebra is compressing any nerves.

Treatment Options For Spondylolisthesis

Treatment depends on the severity of your symptoms and how much the vertebra has slipped. Non-surgical treatments are often effective and may include:

Reducing activities that worsen your symptoms
Taking a break from strenuous activities
Strengthening the muscles in your core that support your spine
Using corticosteroid injections to reduce inflammation and pain around the affected area

In more severe cases where chronic pain or nerve damage occurs, spine surgery might be recommended.

Surgical Treatments for Spondylolisthesis

If non-surgical treatments don’t provide relief, surgery may be necessary. Surgical procedures for spondylolisthesis include:

Spinal decompression surgery. This procedure involves removing bone or soft tissue pressing on the nerves. A part of a vertebra called a laminectomy or a portion of a herniated disc may be removed. The goal is to create more space within the spinal canal and relieve nerve pressure.
Spinal fusion surgery. In spinal fusion, two or more vertebrae are fused together to stabilize the spine and prevent further slippage. Bone grafts, metal rods, screws, or cages may be used to hold the vertebrae in place while they heal and join. Spinal fusion can limit movement between the affected vertebrae, which helps reduce pain. Several surgical methods may be used, including:
- Anterior lumbar interbody fusion (ALIF). This technique involves accessing the spine through an incision in the abdomen.
- Posterior lumbar interbody fusion (PLIF). PLIF is similar to ALIF. However, the spine is accessed through an incision in the back.
- Transforaminal lumbar interbody fusion (TLIF). TILF involves a slightly different approach. The surgeon accesses the spine from one side of the back, allowing for less disruption of the spinal muscles and nerves.

What Happens if Spondylolisthesis is Left Untreated?

In many cases, this condition does not cause significant symptoms, and leaving it untreated is not necessarily dangerous. However, if you start experiencing symptoms like persistent back pain or nerve-related issues, it’s important to seek treatment to prevent complications.

FAQs

Who is most at risk of developing spondylolisthesis?

Degenerative spondylolisthesis, which results from aging and spinal wear and tear, is more common after age 50 and tends to affect women more than men.

Is spondylolisthesis serious?

Spondylolisthesis is not usually considered a serious or dangerous condition. Many people with this condition have mild symptoms or none at all. It only becomes a concern if it leads to nerve compression, disc degeneration, or osteoarthritis, which can cause more significant symptoms and affect your quality of life.