Spondylolisthesis

What is Spondylolisthesis?

Your spine is made up of 24 small bones, known as vertebrae, stacked on top of each other. Spondylolisthesis happens when one of the vertebrae slips out of position. This commonly occurs in the lower back, but can happen in the mid to upper back too. 

This should not be confused with a herniated disc, which is when the rubbery pad that lies between each vertebra is displaced. The word spondylolisthesis is derived from the Greek word for spine, spondylo, and the word meaning to slip or slide, listhesis. 5% to 6% of men have spondylolisthesis, and 2% to 3% of women have it [1].

What does having Spondylolisthesis feel like?

The severity of symptoms differs from person to person, but if you have spondylolisthesis, you can experience one or more of the following symptoms:

  • Lower back pain, similar to a muscle strain that gets worse when you move around or stand up. It might be relieved when you lie down.
  • Sciatica. This is pain, numbness or tingling which spreads from your lower back, down to your buttocks, back of thighs and through your legs.
  • Tight hamstring muscles, causing difficulty standing up or walking. You might stand or walk with a stiff-legged gait.
  • Stiffness/tenderness in your back
  • Muscle spasms/muscle weakness

However, many patients do not experience any symptoms at all. You might not even know that you have spondylolisthesis until it is incidentally discovered in any diagnostic screening test for other conditions. 

What are the causes of Spondylolisthesis?

There are a few different types of spondylolisthesis which have varying causes, namely:

Congenital spondylolisthesis which occurs from birth, when the spine of the fetus develops with misaligned vertebrae. This puts the individual at risk for slippage of the vertebrae as they grow older.

Isthmic spondylolisthesis is a result of spondylolysis. Spondylolysis is when one of the vertebrae has a crack or stress fracture in it. This kind of injury is normally found in children or teens who regularly do sports that place stress on the lower back, like weightlifting and gymnastics. The bone is weakened due to the repetitive trauma, and is likely to slip.

Degenerative spondylolisthesis is the most common kind of spondylolisthesis, which is caused due to old age. As you age, the discs that cushion your vertebrae thin, and are more likely to slip out of place. This is related to degenerative disc disease, where your discs lose hydration.

Traumatic spondylolisthesis is caused by a traumatic injury to the spinal cord which directly causes the slippage of the vertebrae. Post-surgical spondylolisthesis is slippage as a result of spinal surgery.

Pathological spondylolisthesis is caused by a disease such as osteoporosis or a spinal tumour.

How is Spondylolisthesis diagnosed?

Medical examination. When visiting a doctor, your doctor will most likely conduct a thorough medical examination and several tests before definitively diagnosing spondylolisthesis. Your doctor may ask you about your medical history and test your strength and reflexes. 

Neuroimaging. In addition, your doctor may make use of imaging such as MRI and CT scans to have a detailed look at the spine. These types of imaging scans can provide images of your spinal cord and show any cracks or stress fractures in the vertebrae. An MRI can help to determine if there is damage to the discs between each vertebrae, or if a slipped vertebra happens to be pressing on your nerve roots.

How do I prevent myself from getting Spondylolisthesis?

As spondylolisthesis is often caused by natural wear-and-tear of the spine that comes with age, there is no foolproof way to completely prevent spondylolisthesis. However, some ways to reduce your risk of spinal stenosis include:

  • Exercising regularly and not engaging too much in extreme sports that can cause spine damage (weightlifting, gymnastics etc). Exercising helps to strengthen your back muscles and keep your spine flexible. Some sports that are good for the spine include swimming and yoga.
  • Maintaining a good posture. Bad postures can create gradual changes to the natural curves of your spine. Thus, keeping your back straight while sitting down and sleeping on a firm mattress that adequately supports your spine may help to reduce your risk of spinal stenosis.

How is Spondylolisthesis treated?

The goals of treatment for spondylolisthesis would be to reduce pain, allow your spine to heal properly and allow you to return to your daily activities. 

Initial treatment is always non-surgical, and this will usually help you if your spondylolisthesis is low-grade in nature. Your doctor might ask you to rest and take a break from sports. Anti-inflammatory painkillers such as ibuprofen might be prescribed to you to help with your symptoms and you can do some simple stretching and even physiotherapy to help as well. Some patients might need the help of a back brace to limit their spine movement while in recovery.

Back surgery might be recommended for you if non-surgical methods have not worked, or if your symptoms are severe or worsening. There are a few types of operations that can be done, depending on the kind of spondylolisthesis you have. For example, spinal fusion may be done to realign your spine and fuse your affected vertebrae together so that your spine can heal together. Metal screws and rods might also be used to further stabilise your spine.

If you are currently suffering from chronic back pain or think that you may be experiencing spondylolisthesis, visit a doctor and seek medical attention immediately.

Sources

  1. Highsmith, J. M., & MD. (n.d.). Spondylolisthesis Center – Exercises Treatments Surgery. SpineUniverse. Retrieved December 14, 2020, from https://www.spineuniverse.com/conditions/spondylolisthesis
  2. Spondylolisthesis. (2017, October 18). Nhs.Uk. https://www.nhs.uk/conditions/spondylolisthesis/
  3. Spondylolisthesis Imaging: Practice Essentials, Radiography, Computed Tomography. (2019). EMedicine. https://emedicine.medscape.com/article/396016-overview
  4. Spondylolisthesis Treatment, Surgery & Symptoms | Cleveland Clinic. (2014). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10302-spondylolisthesis
  5. Spondylolysis and Spondylolisthesis. (n.d.). OrthoInfo. https://orthoinfo.aaos.org/en/diseases–conditions/spondylolysis-and-spondylolisthesis
  6. Tenny, S., & Gillis, C. C. (2020). Spondylolisthesis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430767/
  7. What Does Your Spondylolisthesis Diagnosis Mean? – Penn Medicine. (n.d.). Penn Medicine. Retrieved December 16, 2020, from https://www.pennmedicine.org/updates/blogs/neuroscience-blog/2017/december/spondylolisthesis