Studies show that up to 4-6% of the U.S. population suffers from either spondylolisthesis or spondylolysis. This translates to a staggering 12,463,676 – 18,695,515 Americans. Further, recent studies show that up to 90% of isthmic Spondylolisthesis is from grade 1 to 2, while 10% of the slips are high grade from grade 3 and above.
What is Spondylolisthesis?
Spondylolisthesis is a condition whereby one of the spine bones, also referred to as vertebrae, slips forward (anterolisthesis) or backwards (retrolisthesis) onto the vertebra below it. When this spine bone slips too much, it is likely to compress on a nerve that exits the canal (foraminal stenosis) or narrowing of the canal of nerves (central stenosis) and in turn the subject experiences too much pain. Spondylolisthesis comes from a Greek word spondylos that means the spine. It also means the ‘vertebra’. Listhesis is also a Greek word that means to slide. There are up to three types of Spondylolisthesis.
There is the congenital Spondylolisthesis, whereby congenital stands for ‘present at birth.’ This condition is as a result of an abnormal formation of born. Here, the disorderly arrangement of vertebrae puts the bones at a great risk of sliding into the vertebra. There is also the Isthmic Spondylolisthesis that occurs due to spondylolysis. Spondylolysis is a condition whereby the vertebrae experience breaks or fractures. These fractures are responsible for the bone weakening that in turn makes it slip out of place. The third type of Spondylolisthesis is called degenerative Spondylolisthesis which is thought to be the most common type of disorder. When a patient ages, their discs, these are cushions that are found between the vertebral bones, lose water and become less spongy and therefore not able to resist the vertebrae movement.
There are also some forms of Spondylolisthesis which are considered to be less common, and these comprise of traumatic Spondylolisthesis, which is essentially an injury that leads to the fracture of the spinal feature or at times a slip. The other less common type of Spondylolisthesis is known as pathological Spondylolisthesis. Here, the spine is often weakened by a disease like osteoporosis or an infection and at times a tumor. Then we have the third type of a less common Spondylolisthesis which is Post-surgical Spondylolisthesis. It is the spillage that occurs after a spinal surgery; at times the spinal surgery may worsen the condition.
Signs of Spondylolisthesis
Before we delve into the symptoms, it’s vital to know the risk factors of Spondylolisthesis. Common risk factors include certain sports that entail hyperextension and rotation, Spinal Bifida Occulta, generalized mobility, Inuit population, facet joint morphology and genetic susceptibility. Females have 2 to 3 times chances of having this condition, and so are men but seldom experience slips. Also, degenerative Spondylolisthesis is likely to affect expectant black women.
Black people are more prevalent to get Spondylolisthesis. This condition is one of a kind, which does not immediately show the symptoms when the slippage occurs. However, a person who has this condition may often present with excruciating low back pain. The pain may extend to the buttocks or often complain of leg pain. You will often have your back aching and have an intense sway back. Also, many people have tight hamstrings, up to 80% of patients presenting with severe tight hamstrings have Spondylolisthesis. Also, the pain may have you limping when walking.
Spondylolisthesis in its severe case may make one to produce neurological signs such as a feeling of numbness or tingling pain. Here, your leg muscles may weaken and experience diminished reflexes. When the spine tries to stabilize the unstable part of the back, facet joints enlarges hence intense pressure on your nerve roots that causes lumbar spinal stenosis and also recess stenosis. When a bone slips forward, there is often a narrowing of the intervertebral foramen this is called foraminal stenosis. Doctors measure the degree of slippage in grade by obtaining and classifying the width of your vertebral body as follows;
- 1st grade 0-25%
- 2nd grade 25- 50%
- 3rd grade 50-75%
- 4th grade 75-100%
- 5th grade 100% plus
Since Spondylolisthesis seldom presents symptoms, a trained spine doctor may always observe it through X-rays or CT scans. These are obtained while the patient lays flat. Mostly though, a slip may be detected when the patient bends forward or stands straight. Spinal surgeon and neurosurgeons obtain flexion standing X-rays or extensions and sometimes the CT myelogram.
Treatment of Spondylolisthesis
The symptoms of Spondylolisthesis can be treated several different ways. One way, is oral steroids to reduce inflammation and irritation. The second is to consider an epidural steroid injection (ESI). An ESI is a method to deliver a steroid medication directly to the segment of your back that is causing your painful symptoms. Physical therapy, is another option to assist is some pain relief for patient with minor symptoms. A physical therapist can assist the patient in hamstrings stretching, lumbar stretching and abdominal strengthening. Although, physical therapy is not recommended if the patient has moderate to severe radiculopathy, or pain radiating to their legs, because it can make the symptoms worse. One is recommended to stretch at least twice every day to ease the pain on the lower back. The exercise program should start gradually and increase as time goes by. The last and final form of treatment that a Miami doctor would recommend would be a fusion surgery. Lumbar fusion could be an option for patients that suffer from back pain radiating to the lower extremities caused by spondylolisthesis. Fusion surgery immobilizes a painful mobile vertebral segment. After fusion surgery to correct spondylolisthesis, the expectations are to walk immediately after surgery with no need for physical therapy or back braces. Patients should go back to their normal life, pain free.