As the body’s most complex structure, the spine is particularly vulnerable to injury and degeneration. One possible spinal condition is spondylolisthesis, which affects the bones of the spine (called vertebrae).
With spondylolisthesis, a vertebra slips out of its normal position and comes to rest on the vertebra beneath it. Whether due to an acute injury or gradual spinal degeneration, spondylolisthesis can become crippling if it’s not promptly addressed.
This article will explore key spondylolisthesis symptoms, what causes them, and how to alleviate them.
What Are the Signs and Symptoms of Spondylolisthesis?
The signs and symptoms of spondylolisthesis include:
- Lower back pain
- Pain that extends into the buttocks and/or thighs
- Tightness and muscles spasms in the hamstring muscles
- Sciatica (nerve pain, numbness, and/or tingling that travels from the lower back through the buttocks and down one leg)
In many cases, spondylolisthesis is asymptomatic, meaning that it doesn’t cause any symptoms. This usually occurs if the misaligned vertebra doesn’t press on any nearby nerves or other soft tissues.
What Is the Most Common Cause of Spondylolisthesis?
The most common cause of spondylolisthesis in adults is age-related spinal degeneration. In children and teens, the most common cause of spondylolisthesis is a vertebral stress fracture.
The aging process and day-to-day strain on the body take a toll on the spine. The cartilage that protects the spinal joints gradually wears away, leading to increased impact on the spinal structures. Additionally, the shock-absorbing spinal discs that protect the vertebrae thin and dry out with age, leaving the vertebrae vulnerable to damage.
Stress fractures from overuse account for most cases of spondylolisthesis in kids and teens. This injury is more common in athletes such as gymnasts, football players, and divers. A vertebral stress fracture can cause instability in the spine, causing the affected vertebra to slip out of position.
Other Causes of Spondylolisthesis
Not all cases of spondylolisthesis are caused by degeneration or overuse. Other possible causes of spondylolisthesis include a sudden impact on the spine and genetic factors.
If the spine is subject to a sudden force, such as an auto accident, a vertebral fracture may occur. This is sometimes referred to as traumatic spondylolisthesis, and it’s relatively rare.
When spondylolisthesis is triggered by genetic factors, it’s typically called congenital spondylolisthesis. This condition develops when the spine doesn’t develop properly in the womb. Patients are born with this condition and may start to experience symptoms in childhood.
What Is the Best Test for Spondylolisthesis?
CT scans are widely considered to be the best test for diagnosing spondylolisthesis. CT stands for computed tomography.
This type of diagnostic test uses X-ray technology to create detailed images of the body. It’s the gold standard for diagnosing spondylolisthesis because it displays the bones in greater detail than other tests.
CT scans and X-rays are easily confused. However, while a single beam of energy is directed at the affected body part during an X-ray, an X-ray beam travels in a circular motion around the body during a CT scan. As a result, a CT scan offers multiple angles of the body part, while an X-ray produces just one.
Many cases of spondylolisthesis can be successfully diagnosed with a simple X-ray. But, to gather more information about the affected vertebrae and diagnose complex spondylolisthesis cases, CT scans are preferred. If spondylolisthesis causes significant damage to surrounding tissues, an MRI scan may also be used for its superior soft tissue contrast.
What Is the Best Treatment for Spondylolisthesis?
The best treatment for spondylolisthesis is physical therapy and lifestyle adjustments. To cure the condition in advanced cases, decompressive laminectomy with a form of stabilization is the best surgical treatment option.
Physical Therapy for Spondylolisthesis
Physical therapy is a drug-free treatment that focuses on improving body mechanics, alleviating muscle tension, and boosting support for the spine. Your physical therapist can prescribe a variety of spondylolisthesis exercises to enhance the strength of your core and back muscles. This will reduce the strain on your spine with day-to-day motions and allow the painful tissue to heal.
Your physical therapist may also implement treatments like heat/cold therapy, massage, electrical stimulation, and ultrasound therapy. These methods help spondylolisthesis patients manage inflammation and pain.
Other Non-Surgical Spondylolisthesis Treatments
Physical therapy isn’t the only conservative treatment method used to manage spondylolisthesis symptoms. Other options include:
- Lifestyle modifications, like avoiding activities that strain the spine
- A brace to stabilize the spine (this treatment is only used in children and teens with spondylolisthesis)
- Pain medications, including over-the-counter anti-inflammatory drugs (such as NSAIDs) and prescription muscle relaxants
- Epidural steroid injections, which relieve pain in the spine reducing the immune response in the affected area, which in turn reduces inflammation
It’s important to know that medications, including steroid injections, come with various risks and possible side effects. Talk to your doctor about all of the medications you’re currently taking before starting a new drug. Additionally, medications aren’t considered a long-term solution to spondylolisthesis, as they can only alleviate the patient’s symptoms – not address the condition’s root cause.
Surgery for Spondylolisthesis
When conservative spondylolisthesis treatments don’t offer symptom improvement after several months, your physician may recommend surgery. Decompressive laminectomy, as we mentioned above, is widely used for spondylolisthesis with a form of stabilization. Laminectomy involves removing the lamina to alleviate nerve compression caused by the displaced vertebra.
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Given that spondylolisthesis causes spinal instability, decompressive surgery is rarely used alone. Conventionally, surgeons have used spinal fusion to stabilize the spine after decompression surgery. Fusion involves placing bone graft material between the afflicted vertebra so that they fuse into one bone.
Unfortunately, spinal fusion can cause limited mobility and adjacent segment degeneration in spondylolisthesis patients (not to mention an extensive recovery process). Non-fusion implants like the revolutionary TOPS System can stabilize the spine after surgical decompression without jeopardizing the patient’s mobility.
Patients suffering from spondylolisthesis symptoms should speak with an experienced spinal specialist to learn about the complete range of treatment options available to them.