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Spondylolisthesis

Spondylolisthesis is a condition in which one of the vertebra slips over the vertebra below it. There are various causes. A common cause of spondylolisthesis is a stress fracture in a part of a vertebra (isthmic spondylolisthesis). Spondylolisthesis can also occur as a result of age-related degenerative changes in the spinal discs or vertebrae (degenerative spondylolisthesis).

*Always consult a doctor for pain that spreads down your leg or is accompanied by tingling, numbness or weakness.

Isthmic Spondylolisthesis

Isthmic spondylolisthesis is a caused by a stress fracture in a part of a vertebra. (A crack in a vertebra, without slippage, is called spondylolysis.) A crack in a vertebra often doesnt heal because of the constant stress on the lower back.

Sports (such as gymnastics, football, and weightlifting) that place repetitive, excessive stress on the lower vertebrae and/or involve hyperextension of the spine increase the risk of stress fractures. Sometimes a genetic weakness or malformation in part of the vertebrae leaves a person predisposed to stress fractures.

Not all stress fractures in a vertebra result in slippage.

A stress fracture in a vertebra may cause it to disconnect from the facet joints. This results in the vertebra slipping forward over the vertebra below it - resulting in misalignment and narrowing in the spinal canal. Spinal nerves may be compressed. The degree of slippage can vary. An X-ray can show the degree of slippage. The slippage may or may not progress.

Isthmic Spondylolisthesis starts with a stress fracture in a part of a vertebra called the pars interarticularis (a narrow piece of bone connecting the facet joints). Facet joints are hinge-like joints attached to the back of each vertebra (in pairs - one on each side of the back of the vertebrae) that link the vertebrae together and allow the vertebrae to move on one another.

About 5% of adults have isthmic spondylolisthesis, though many are not aware of it.
Some people are surprised to find out they have a slipped vertebra after having it show up on an x-ray.

The stress fracture most often occurs in early childhood but the slippage often occurs later - during periods of rapid growth. Slippage is uncommon after adolescence. Sometimes the slippage occurs in childhood, is present for years without symptoms, but often accelerates disc degeneration later in life.

Isthmic spondylolisthesis most commonly affects the bottom vertebra in the lower back just above the sacrum (a triangular shaped solid base consisting of 5 fused vertebrae).

Symptoms of Isthmic Spondylolisthesis

There may be no symptoms at all or there may intermittent or chronic symptoms. Pain is the main symptom. There may also be tingling, weakness or numbness radiating down the buttocks and leg (sciatica), caused by compression or irritation of nerve roots. Inflammation may trigger muscle spasms, which cause pain, stiffness in the back and sometimes an abnormal gait. Tightness in the hamstrings is another fairly common symptom of isthmic spondylolisthesis that can cause difficulty walking.

The symptoms usually flare up after prolonged standing or walking and are relieved by rest. The symptoms may be chronic or intermittent.

Spondylolisthesis does not always cause symptoms.

Treatment

Treatment depends on severity of slippage, the cause of the slippage, the severity of the symptoms, and age of the person. When a child diagnosed with spondylolisthesis, x-rays are taken routinely to see if the slippage is progressing.

Though spondylolisthesis is a chronic condition, conservative treatment is usually adequate. Surgery is rarely needed. If symptoms are severe, a few days of bed rest may be necessary. Prolonged bed rest, however, weakens the muscles that support the spine and is counterproductive.

Avoid activities that stress the lower back such as lifting heavy objects.

Exercise

Consult a physician before starting an exercise plan. Do not do any exercise that causes pain.

Stretching the muscles of the lower back relieve muscle spasms. Stretching the hamstrings also helps. Strengthening the muscles that support the lumbar spine  both back and abdominal muscles are particularly helpful. Strong muscles and ligaments help hold the vertebrae in place.

Low impact aerobics tone the muscles in the back without placing undue stress on the spine. Low impact aerobics include walking, swimming, or riding a stationary bike or elliptical trainer. Aerobics also help keep ones weight under control; being overweight increases stress on the lower back.

Medication

Anti-inflammatory medications are useful for short-term pain and inflammation. See Medications for Pain and Inflammation.

Cold

When there is a flare up of symptoms, applying ice packs to the area every three to four hours for two to three days can reduce pain and inflammation. Do not apply ice for over 20 minutes at a time to prevent frostbite. Place a cloth between the ice and the skin.

Heat

Applying heat to the area can relieve muscle spasms. Apply heat for 20 - 30 minutes at a time, waiting at least an hour between each application to prevent overheating of tissues. Moist heat penetrates the tissues more quickly, and penetrates more deeply than dry heat. A hot bath or shower also helps to relax muscles

Bracing

Some physicians recommend wearing a lumbosacral brace. Bracing relieves symptoms for some people.

Epidural Steroid Injections

An injection of steroids into the epidural space surrounding the spinal cord may reduce pain and other symptoms caused by compression or irritation of nerve roots. An epidural steroid injection is a minimally invasive procedure with rare but serious risks. It is used only after conservative therapies have not provided adequate relief.

Surgery

Surgery may be recommended when conservative treatment fails to bring adequate relief and symptoms are severe enough to interfere with everyday life. Surgery may also be recommended when the affected vertebra continues to slip further. Fusing the affected vertebra to the vertebra below it (or fusing the lowest lumbar vertebra to the sacrum) prevents further slippage. If a nerve root is being compressed, bone or tissue compressing the nerve can be removed make more room for the nerve.

Fortunately, the majority of cases respond to conservative treatment.

Always consult a physician to receive a proper diagnosis and an appropriate treatment plan.