Spinal Problems Bone Spondylolisthesis

Spinal spondylolisthesis occurs when one vertebra slips out of place (usually forward) relative to an adjacent vertebra. The grade of spondylolisthesis is specified by the ratio of the amount of slippage to the width of the vertebral body:

  • Grade 1 is a ratio of 0 to 25 percent
  • Grade 2 is 25 to 50 percent
  • Grade 3 is 50 to 75 percent
  • Grade 4 is 75 to 99 percent
  • Grade 5 is 100 percent (this complete vertebral slippage is known as “spondyloptosis.”)

The most common cause of spondylolisthesisis is spondylolysis (called spondylolytic spondylolisthesis). Spondylolysis is a weakness in a connection between the vertebrae (in an area called the pars interarticularis) that can lead to small stress fractures of the vertebrae. This can progress to spondylolisthesis.

Although the exact cause of the pars interarticularis weakness is unknown, it’s generally believed to be either:

  • A congenital problem where someone is born with thin vertebrae, which places them at higher risk for fractures.
  • The result of repetitive trauma to the lower back, particularly due to playing sports (teenage athletes are especially susceptible to spondylolysis).

In children and teenagers, spondylolisthesis generally occurs between the fifth lumbar vertebra (L5) and the first bone in the sacrum (S1). In adults, lumbar spondylolisthesis usually occurs between the fourth (L4) and fifth (L5) lumbar vertebrae, due to a degenerative disease such as arthritis.

Other, less common causes of spondylolisthesis include bone diseases and traumatic fractures.

Symptoms of Spondylolisthesis

Spondylolisthesis may have no symptoms. When symptoms are present, they range greatly in severity, and may include:

  • Lower back pain
  • Muscle tightness, especially in the hamstring muscles
  • Pain in the thighs and buttocks
  • Stiffness
  • Tenderness in the area of the slipped vertebra.

If the slippage presses on nerves, weakness or pain may radiate down the legs. Sometimes spondylolisthesis causes an increased curve in the lower back (swayback). In advanced stages, spondylolisthesis may cause kyphosis (rounding of the upper spine) as the upper spine falls off the lower spine.

Treatment for Spondylolisthesis

Spondylolisthesis treatment depends on the grade of the condition. Low-grade spondylolisthesis may require no treatment other than observation and avoiding certain activities (such as heavy lifting and stooping) that cause symptoms.

For acute pain and inflammation, anti-inflammatory and pain-reducing medications are an option. Physical therapy is also often recommended. Oftentimes, spondylolisthesis symptoms improve with strengthening and stretching exercises combined with modifying activities. Some doctors recommend a rigid back brace for more severe cases of the disease.

If nerve problems develop or other treatment does not work, surgery is an option. Various surgical options are available. You’ll need to talk with your spine surgeon to determine the best option for your condition.

Resources

Dawson, E. (2010). Spondylolisthesis. Retrieved March 27, 2010, from http://www.spineuniverse.com/conditions/spondylolisthesis/spondylolisthesis

Dawson, E. (2010). How doctors treat spondylolisthesis. Retrieved March 27, 2010, from http://www.spineuniverse.com/conditions/spondylolisthesis/how-doctors-treat-spondylolisthesis

Irani, Z. (2009). Spondylolisthesis. Retrieved March 27, 2010, from http://emedicine.medscape.com/article/396016-overview

Medline Plus Staff. (2008). Spondylolisthesis. Retrieved March 27, 2010, from http://www.nlm.nih.gov/medlineplus/ency/article/001260.htm