What is Spondylolisthesis?
Spondylolisthesis is a condition involving the spine or the vertebrae characterized by either a backward or forward displacement in relation to the spine under it. Slippage of spine in Spondylolisthesis more commonly occurs at L5 S1 or the base of the spine in the region of the lumbar although the slippage may also occur in other areas or in higher levels of the spine.
Spine or the vertebral column has a vital function in human. The spine serves in providing support and maintaining balance while keeping an upright position while it also allows for motion in flexible manner in humans. The spine also functions in protecting several nerves of the internal organs of the body including the roots and spinal cord. The spine has different specific functions relative to its main regions. The cervical spine is the region of the spine found at the neck that composed of seven vertebrae. Cervical spine functions mainly in allowing movement of the head while supporting the skull and protecting the spinal cord and the brain stem. The next region of the spine is the thoracic spine which consists of twelve vertebrae. The thoracic spine together with the rib attachments provides for stability while protecting the vital organs together with the rib cage. The third region of the spine is the lumbar spine that composed of five vertebrae. The function of which is to hold the weight of the human body in which the shape and size of each lumbar vertebrae is designed to function. Sacral spine or the sacrum is the fourth region of the spine that fuses the spine with the pelvis while the last area of lumbar spine or L5 moves with the help of the sacrum.
It is important that the anatomy of the spine be understood by patient suffering from spondylolisthesis. It is for them to understand the importance of the spine and the pain associated with the condition so as to give importance and seek prompt medication and prevent possible complication or severe damage with the spine if the condition is left untreated otherwise, may pose potential fatality to patient.
Symptoms of Spondylolisthesis
Spondylolisthesis can occur without any symptoms and patient suffering from may not know that they already have the condition. The symptoms however, when they occur, can go from mild to moderate and the usual onset initially is with lower back pain. The lower back pain normally radiates to the lower back with pain felt similar to a muscle strain. The lower back pain is also associated with a shooting pain radiating from the buttocks to the thigh that passes trough the sciatic nerve. A change in posture and gait is noticeable as a result of hamstring tightening and stiffening of the back. Tingling and numbness may also be felt in the lower leg while the pain in the lower back can be exaggerated with coughing or sneezing. Assuming a standing position coming from a sitting position can be difficult due to pain.
Multiple factors are considered for the cause of spondylolisthesis and the condition was classified into five major types according to its cause and these are the following:
Degenerative spondylolisthesis is among the common form of spondylolisthesis which often results from aging when the disc that cushions the vertebral bones becomes less spongy with lessened ability in resisting movement from the vertebrae. The resulting spondylolisthesis is mainly the result of changes in the joints from degeneration which is normal in the aging process. This form is common in older people as a result of normal wear and tear brought by aging.
Congenital or dysplastic spondylolisthesis is a form of spondylolidthesis that is present at birth. The slippage and displacement in the spine is the result of an aberration in the formation of bone during the fetal development in the womb. The aberration in the formation of the bone in fetus during its development is potentially at risk for slippage as the child grows and develops. The malformation in this form of spondylolisthesis is usually located in the lumbosacral junction.
Isthmic spondylolisthesis is the result of a defect in the pars interarticularis. This form of spondylolisthesis is prevalent in athletes as isthmic spondylolisthesis is usually the result of repetitive trauma that is usual in contact sports that most athletes encounter including the hyperextension that they usually do with their sports.
Traumatic spondylolisthesis is a form of spondylolisthesis that resulted from a direct injury to the vertebrae. This is a very rare form of spondylolidthesis that is due to a fracture in the pars interarticularis or the posterior facets resulting to a forward slip or displacement in relation to the rear segment of the vertebrae.
Pathologic spondylolisthesis is a form of spondylolidthesis that is caused by a bone deformity that resulted from tumor growth and metastases or any metabolic disease of the bone. Spondylolisthesis of this form is often seen in patients suffering from giant cell tumors and those with Piaget’s bone disease including tuberculosis.
The initial step in diagnosing spondylolisthesis is through taking of medical history of the patient. Doctors usually and take note of the signs and symptoms and its severity including any medications taken. Familial medical history is also being considered including activities that could contribute to complains of pain in the lower back and legs.
Physical examination is also applied especially considering the limitations in movements including the pain perceived and difficulty in balancing and posture and gait. Other signs for neurological damages are also being noted to rule out spondylolisthesis or any other condition that is causing the chief complains of lower back pain and leg pain.
Diagnostic test in confirming spondylolisthesis is done with recommendation of imaging test initially with x-ray in ruling out tumor growth and infection. Identifying nerve compression linked to spondylolisthesis can be verified utilizing MRI or computed tomography scan. PET scan is also useful especially in identifying the activeness in the affected bone.
Spondylolisthesis has a good prognosis and usually respond to conservative treatment without recurrence. The mode of treatment however, depends on the cause of the condition and the severity of the symptoms in which the goal of treatment is through alleviation of symptoms while preventing further complications. Factors are considered prior to application of treatment such as the age of the patient, the over-all health status, severity of symptoms and the extent of slip or displacement.
Conservative treatment for spondylolisthesis includes sufficient rest for patient. Discontinuation of rough activities or any other activities especially those requiring hyperextension movements are prescribed for a period of time or until the condition has completely resolved. Medication is included in the conservative treatment especially in the alleviation of pain. Over-the-counter pain reliever especially non-steroidal anti-inflammatory drugs such as Ibuprofen and naproxen can help in relieving the symptoms of pain. Epidural steroid injection is beneficial to patient with severe pain and with numbness and tingling sensation in the legs. Hyperextension brace is beneficial to patients suffering from isthmic spondylolisthesis. This type of brace allows for healing to occur by binding together the defective bone to the unaffected. The back brace also allows for stability of the lower back while the pain is also being reduced.
This is beneficial in strengthening the abdominal and back muscle while diminishing bony movement in the spine which can aggravate more the pain and displacement. Physical therapy specially utilizes stabilization exercises that are generally prescribed at eight to twelve weeks in aggressive treatment to achieve the optimum improvement of overall health and stability of the patient in terms of spinal use and functions.
Surgical intervention is advised for patient with severe pain and continuous spine slippage even after conservative management has been applied. The goal in this mode of management in spondylolisthesis is to relieve symptoms unresponsive to conservative treatment and stabilizing spine slippage while restoring the normal function of the patient. Decompressive laminectomy is done to generate more room for the nerve being compressed with spinal fusion follows to create stability in spine through use of screws or rods to grip the vertebra firmly while in the process of healing.
Meyerding grading system is the method used for identifying the extent and severity of slip in the spine which can range from mild to severe and with grading from I to IV respectively.
Grade I is from 0 to 25% of slippage
Grade II is from 25 to 50% of slippage
Grade III is from 50 to 75% of slippage
Grade IV is from 75 to 100% of slippage
Both Grade I and Grade II generally do not require surgical intervention while Grade III and Grade IV may require surgery which may have persistent symptom of pain and presence of slip in the spine.