What is Spondylolisthesis?
Spondylolisthesis is a condition where one vertebra slips forward over the one below it. This misalignment can cause back pain, nerve compression, and reduced mobility. It most often affects the lower lumbar spine but can occur in other regions.
Types of Spondylolisthesis
Congenital Spondylolisthesis: Present at birth due to abnormal bone development.
Isthmic Spondylolisthesis: Caused by a stress fracture in a part of the vertebra called the pars interarticularis.
Degenerative Spondylolisthesis: Results from age-related changes in discs and joints.
Traumatic Spondylolisthesis: Caused by acute injury to the spine.
Pathologic Spondylolisthesis: Due to disease processes such as tumors or infections.
Causes
• Repetitive stress fractures (especially in athletes).
• Degenerative changes in the spine due to aging.
• Congenital spinal defects.
• Trauma or injury.
• Bone diseases weakening the vertebrae.
Symptoms
• Lower back pain that may worsen with activity.
• Pain radiating into the buttocks or legs.
• Muscle tightness or spasms.
• Stiffness in the lower back.
• Numbness, tingling, or weakness in the legs.
• Difficulty walking or standing for long periods.
Diagnosis
Diagnosis begins with a physical exam and medical history. Imaging studies confirm the diagnosis and grade the severity:
– X-rays to visualize vertebral slippage.
– MRI to assess nerve compression and soft tissue.
– CT scan for detailed bone imaging.
– Flexion-extension X-rays to see movement between vertebrae.
Conservative Treatment
• Rest and avoidance of activities that worsen symptoms.
• Nonsteroidal anti-inflammatory medications (NSAIDs).
• Physical therapy to improve strength and flexibility.
• Bracing to stabilize the spine.
• Epidural steroid injections for nerve inflammation.
Surgical Treatment
• Spinal fusion – Stabilizes the affected vertebrae to prevent further slippage.
• Laminectomy – Removes part of the bone to relieve nerve pressure.
• Reduction – Re-aligning the slipped vertebra before fusion.
Surgery is typically recommended for severe pain, progressive slippage, or significant nerve compression causing weakness.
Frequently Asked Questions
Q: Can spondylolisthesis heal on its own?
A: Mild cases often improve with conservative treatment, but the vertebra does not usually move back into place without surgery.
Q: Is exercise safe?
A: Gentle exercises are typically recommended, but activities causing pain should be avoided.
Q: How is spondylolisthesis graded?
A: It is graded based on the percentage of slippage, from Grade I (mild) to Grade V (complete slippage).
Q: Will I need surgery?
A: Most cases improve without surgery, but severe cases may require operative treatment.