What is spondylolisthesis?

Spondylolisthesis is a lower back condition in which a bone (vertebra) in the lower part of the spine slips forward and onto a bone below it.

Causes of spondylolisthesis

•  Birth defect: In children, spondylolisthesis usually occurs between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum area. It is often due to a birth defect in that area of the spine.

•  Degenerative disease: In adults, the most common cause is degenerative disease (such as arthritis). The slip usually occurs between the fourth and fifth lumbar vertebrae.

•  Other causes: Stress fractures (commonly seen in gymnasts) and traumatic fractures. Spondylolisthesis may occasionally occur because of bone diseases.

Symptoms of spondylolisthesis

Some of the symptoms that often accompany spondylolisthesis are:

•  Increased lordosis (i.e., swayback or saddle back)

•  Lower back pain, especially after exercise

•  Localized tenderness over the spine just above the pelvis

•  Neurological damage (leg weakness or changes in sensation) may cause pain in the legs and thighs

•  Pain in the buttocks

•  Reduced ability to control bowel and bladder functions

•  Tight hamstrings

•  Stiffness in back

•  Kyphosis (roundback) in later stages as the upper spine falls off the lower spine

However, it should be noted that many people with a spondylolisthesis will have no symptoms, and will only become aware of the problem when it is revealed on an X-ray for a different problem.

Diagnosis

•  X-ray of the spine (demonstrates misalignment of lumbar vertebra, and possible fracture)
•  A straight leg raise may be uncomfortable or painful

Prevention

People with marked lordosis should avoid back hyperextension (leaning way back), weight lifting, and contact sports. Lower back pain, although common in preadolescent and adolescent children, should be evaluated, especially in the presence of marked lordosis.

Treatment options

Treatment varies depending on the severity of the spondylolisthesis.

Conservative treatment
Most patients require only strengthening and stretching exercises combined with activity modification (avoiding hyperextension of the back and contact sports). Some practitioners also use a rigid brace.

Surgical treatment
For cases with severe pain not responding to therapy, if the slip is severe, or there are neurologic changes, surgical intervention may be necessary. The slipping vertebra is surgically fused using the spinal fusion surgery . This surgery has a higher incidence of nerve injury than most other spinal fusion surgeries. A brace or body cast may be used after surgery. In some cases, fusion with decompression may be used.

Risks and complications

•  Nerve compression
•  Temporary or permanent damage of spinal nerve roots, which may cause sensation changes, weakness, or paralysis of the legs
•  Chronic back pain

Suggested Reading

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