Spondylolisthesis is the condition, that affect the moveable joints of the spine. Spondylolisthesis is a degeneration of articulating (exterior) part of the vertebrae that reduces its strength, integrity, support and flexibility. The articulating part that is affected is in the rear of the vertebrae and tends to be located in L4 or L5 of the lumbar (lower back).
Anatomy of Spondylolisthesis
Spondylolisthesis describes a vertebra that has slipped forward on the vertebra below. This usually occurs when a vertebra has a bony defect (spondylosis) on both sides of the bony ring. A crack on both sides of the bony ring separates the facet joints from the back of the spinal column. The facet joint can no longer steady the vertebra.
The vertebra on top starts to slide forward, slowly stretching the disc below the damaged vertebra. In adults, there is usually no danger that the vertebra will slide off the vertebra below. But teenagers sometimes have a unique type of spondylolisthesis in which one vertebra slips forward and slides completely off the vertebra below.
Causes of Spondylolisthesis
Spondylolisthesis is usually the result of age and "wear and tear" on the spine that breaks down vertebral components.
Spondylolisthesis is most often caused by spondylolysis. Spondylolisthesis can be present at birth or occur through injury.
Repeated stress fractures caused by hyperextension of the back (as in gymnastics and football) and traumatic fractures are also causes. The most common cause in adults is degenerative arthritis.
Other Causes of Spondylolisthesis : -
Fractures affecting spine.
Physical stresses like heavy weight lifting work outs.
Injury to the spine by sudden fall or accident.
Abnormal development of spine bones.
Symptoms of Spondylolisthesis
Back pain is the most common symptom of spondylolisthesis. Pain in the back and buttocks is present in up to 80% of individuals with spondylolisthesis.
Other Symptoms associated with spondylolisthesis include : -
Back pain which is aggravated by strenuous activity, relieved with rest.
Tightness or weakness of hamstring, If the hamstring tightness is severe enough to shorten the length of each step, a waddling gait may be noted.
Leg pain is worse by activity and relieved by rest; frequently seen in adults
Radiculopathy - low back pain that radiates into the buttocks and down the legs, numbness, and disturbances in sensation, such as tingling, in the extremities. Radiculopathy may occur with more severe degrees of slippage. The pain follows directly along the path of a specific spinal nerve root. It is usually secondary to compression, inflammation, or injury to the nerve root.
Bladder and bowel dysfunction - may occur with severe degrees of slippage and stretching of L5-S1 nerve roots
Tenderness and irregularities in bony alignment that may be felt or palpated
Shortened appearance of the trunk and lumbar hyperlordosis (inward curvature of the spine)
Diagnosis of Spondylolisthesis
A number of test may be used to aid in the diagnosis of spondylolisthesis and to locate the affected bone, including : -
X-ray : - High-energy radiation is used to take pictures of the spine.
Magnetic Resonance Imaging (MRI) : - An MRI provides detailed pictures of the spine that are produced with a powerful magnet linked to a computer.
Computed Tomography (CT) Scan : - A CT scan uses a thin X-ray beam that rotates around the spine area. A computer processes data to construct a three-dimensional, cross-sectional image.
Treatment of Spondylolisthesis
Non Surgical Treatment of Spondylolisthesis
Nearly 65 to 85% of the patients respond to the conservative treatment with resolution of symptoms. Patients with no symptoms does not require any treatment.
Individual with symptomatic spondylosis may be managed conservatively without surgery which includes : -
Short course of bed rest
Restriction of strenuous activity
Lifestyle modification which include weight maintenance with diet and appropriate exercises and cessation of smoking
Mild analgesics.
Surgical Treatment of Spondylolisthesis
The traditional surgical treatment consists of decompression of neurological tissue followed by a fusion without reduction of the slipped vertebra or instrumentation. Pedicle fixation instrumentation was introduced later and seems to increase the fusion and success rate.
The most recent surgical treatment consists of decompression of the neurological tissue, reduction of the spondylolisthesis with restoration of the anatomy, followed by an anterior and posterior fusion and instrumentation.
An extensive back rehabilitation programme to restore normal function should always follow the surgical treatment.
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