Spondylolisthesis

The word spondylolisthesis comes from the Greek - spondylos, meaning “vertebra” and olisthesis, meaning “dislocation.” With this condition, one of the vertebrae in the spinal column slips out of alignment and is displaced forward onto the vertebra below. If the vertebra is displaced too far forward, it can narrow the space in the spinal canal, as well put pressure on adjacent nerves. The lower back (lumbar spine) is most commonly affected.
There are several different types of spondylolisthesis. The 3 most common types are listed below.

Degenerative spondylolisthesis — Generally occurs after age 40 and most commonly seen in female patients over age 60. This type is caused by degenerative changes to the vertebrae/discs. Over time, the discs lose their cushioning effect and become less resistant to movement by adjacent vertebrae.  Displaced vertebrae can narrow the space in the spinal canal, leading to spinal stenosis.

Isthmic spondylolisthesis — Most often caused by stress fracture/s (crack/s) to a vertebra. A fracture of the pars interarticularis (small bone that connects the facet joints) can cause the vertebra to disconnect from the facet joints (the hinge-like joints that link the vertebrae together). Sports that involve repetitive stress to the lumbar vertebrae and/or entail hyperextension of the spine increase the risk for stress fractures and vertebral slip. Weightlifters, football players, and gymnasts may suffer from this disorder because of considerable spinal stress.

In addition, some individuals are born with slight malformations in the spine, predisposing them to stress fractures.

Congenital spondylolisthesis — This type is present from birth and is caused by abnormal bone formation in the spine. The spinal misalignment puts the vertebrae at greater risk for slipping out of place.

Other, less common types of spondylolisthesis include:

Pathological spondylolisthesis  - This condition is brought on by disease (e.g. osteoporosis), infection, or abnormal growths (e.g. tumors) that cause bone weakness.

Post-surgical spondylolisthesis – Vertebrae can become displaced as a result of surgery.

Traumatic spondylolisthesis – Direct injury to the spine can cause spinal fractures or displacement of vertebrae.

 

Symptoms

Not all patients find the condition painful. Some people are symptom-free and only discover the disorder when seeing their doctor for another health problem.

Symptoms of spondylolisthesis may include:

  • Lower back pain – most common symptom
  • Decreased range of motion, i.e., a “stiff” back
  • Lower back pain worse after exercise
  • Sciatica
  • Muscle spasms
  • Leg pain, weakness, and/or numbness due to nerve compression
  • Tight hamstring muscles
  • Irregular gait or limp

 

Accurate Diagnosis Essential

Doctor Frazier carefully analyzes your written medical history and opens up discussion by asking you many questions about your symptoms, when symptoms started, treatments tried, hereditary disorders, existing conditions, and lifestyle.

During the physical and neurological examinations, Dr. Frazier evaluates movement limitations, problems with balance, location of pain.  He tests superficial and deep tendon reflexes, determines the extent of muscle weakness, and evaluates loss of feeling and/or abnormal sensations such as numbness or tingling.

Imaging studies may be necessary to reveal more information about your symptoms and to confirm your diagnosis. Dr. Frazier will most likely start with x-rays. Spondylolisthesis is easily seen on a lateral (side) lumbar x-ray. If additional imaging is required, Dr. Frazier may order a CT scan or MRI.

To ensure the most accurate diagnosis, Dr. Frazier has access to a complete range of advanced diagnostic equipment including high-speed Magnetic Resonance Imaging (MRI), Computerized Tomography (CT scan), bone densitometry (DEXA), myelography, and discography.

 

Classification of Spondylolisthesis

Information from your medical file and imaging studies is used to grade the degree of vertebral slippage from mild to severe.  The grade of your spondylolisthesis is explained to you along with what it means.

The Meyerding Grading System is used to classify the extent of vertebral displacement. The grade of spondylolisthesis is determined by the degree to which the vertebral body has slipped forward over the vertebral body below.

The degree of slippage is obtained from your spinal x-rays and graded as follows:
Grade I:  1-25%
Grade II: 26-50% 
Grade III: 51-75%
Grade IV: 76%-99% slip.
Grade V: Complete slip (100%), known as spondyloptosis.

Dr. Frazier considers the degree of slip and other factors such as intractable pain and neurological symptoms, when determining your treatment. Most cases of spondylolisthesis are Grade I or II.  As a general rule, more severe slips (Grades III and higher) are most likely to require surgical intervention.

 

Non-surgical Treatment

Most cases of spondylolisthesis are treated without surgery. Treatment may include:

  • Short-term bed rest
  • Activity restriction
  • Over-the-counter or prescription pain medication
  • Anti-inflammatory medication
  • Muscle relaxants
  • Steroid injections (i.e. epidural steroid injection)
  • Physical therapy
  • Bracing

Spondylolisthesis can worsen over time. It is important to follow-up with Dr. Frazier so that he can monitor your condition and adjust your treatment plan accordingly.

 

When Spine Surgery May Be Recommended

Besides the severity of the slip, there are other factors Dr. Frazier takes into consideration before surgery is recommended. For example, if your symptoms worsen and your condition does not improve with non-operative therapies, you may be encouraged to explore more aggressive treatment. Should you develop neurologic problems such as incontinence, surgery may be your only option.

 

Surgical Treatment of Spondylolisthesis

Surgery for spondylolisthesis is designed to relieve nerve pain, stabilize the spine, and increase level of function. Spinal instrumentation (i.e. rods, screws) and fusion (bone graft) are commonly done to halt slip progression and stabilize the spine. There are different types of instrumentation, bone graft and graft products, as well as minimally invasive procedures to treat spondylolisthesis. Your surgical options may include combined procedures such as repair of the pars interarticularis, decompression, spinal fusion, and deformity correction.

If Dr. Frazier recommends spine surgery, he will carefully explain to you:

  • Why he recommends surgery
  • How surgery may be of benefit
  • Possible risks and complications
  • When (how soon) is surgical treatment needed
  • Procedure name and type
  • How to prepare for surgery
  • Surgery aftercare and recovery

Understanding your diagnosis and the particulars about your spine surgery is essential to making an informed treatment decision.  Dr. Frazier and his professional staff have a deep commitment to patient education and welcome all questions.

Have you been diagnosed with Spondylolisthesis? If you would like a consultative appointment with Dr. Frazier to treat your Spondylolisthesis, please complete this form.